- A 60-year-old patient with COPD presents with a respiratory rate of 28 breaths/min and an SpO2 of 88%. What is the most appropriate initial action?
A) Administer high-flow oxygen at 15 L/min
B) Initiate noninvasive positive pressure ventilation (NPPV)
C) Administer low-flow oxygen at 2 L/min via nasal cannula
D) Order a chest X-ray
Answer: C) Administer low-flow oxygen at 2 L/min via nasal cannula
Rationale: COPD patients are at risk of hypercapnic respiratory failure due to oxygen-induced hypoventilation. Low-flow oxygen (1–2 L/min) is recommended to maintain SpO2 between 88–92%, avoiding excessive oxygen delivery.
- A patient’s arterial blood gas (ABG) shows: pH 7.32, PaCO2 55 mmHg, HCO3 28 mEq/L, PaO2 70 mmHg. What is the acid-base status?
A) Compensated respiratory acidosis
B) Uncompensated metabolic alkalosis
C) Uncompensated respiratory acidosis
D) Compensated metabolic acidosis
Answer: A) Compensated respiratory acidosis
Rationale: The low pH (7.32) indicates acidosis, and the elevated PaCO2 (55 mmHg) suggests a respiratory cause. The slightly elevated HCO3 (28 mEq/L) indicates partial compensation by the kidneys, consistent with compensated respiratory acidosis.
- During a patient assessment, you note jugular vein distention and peripheral edema. What condition is most likely?
A) Left ventricular failure
B) Right ventricular failure
C) Pneumothorax
D) Pulmonary embolism
Answer: B) Right ventricular failure
Rationale: Jugular vein distention and peripheral edema are signs of right ventricular failure, often due to increased pulmonary vascular resistance, causing blood to back up into the systemic circulation.
- A 45-year-old patient reports shortness of breath and has a respiratory rate of 24 breaths/min. Pulse oximetry shows an SpO2 of 90%. What should you do first?
A) Administer a bronchodilator
B) Apply supplemental oxygen
C) Order an arterial blood gas
D) Perform a peak flow measurement
Answer: B) Apply supplemental oxygen
Rationale: An SpO2 of 90% indicates hypoxemia. The first step is to administer supplemental oxygen to improve oxygenation, typically targeting SpO2 of 94–98% in non-COPD patients.
- A patient with a history of asthma has a peak expiratory flow rate (PEFR) of 50% of predicted. What does this indicate?
A) Normal lung function
B) Mild asthma exacerbation
C) Severe asthma exacerbation
D) Chronic obstructive pulmonary disease
Answer: C) Severe asthma exacerbation
Rationale: A PEFR of 50% or less of predicted indicates a severe asthma exacerbation, requiring immediate intervention such as bronchodilators and possibly corticosteroids.
- A 70-year-old patient with pneumonia has a temperature of 38.5°C and a heart rate of 110 bpm. What is this heart rate classified as?
A) Bradycardia
B) Normal
C) Tachycardia
D) Arrhythmia
Answer: C) Tachycardia
Rationale: A heart rate above 100 bpm in adults is classified as tachycardia, often seen in response to fever, infection, or hypoxia, as in pneumonia.
- A patient’s chest X-ray shows a hyperlucent lung field and a deviated trachea to the right. What is the most likely diagnosis?
A) Left-sided pneumothorax
B) Right-sided pneumothorax
C) Pulmonary edema
D) Pleural effusion
Answer: B) Right-sided pneumothorax
Rationale: A hyperlucent lung field and tracheal deviation to the opposite side (right) suggest a right-sided pneumothorax, where air in the pleural space causes lung collapse and mediastinal shift.
- When assessing a patient, you note inspiratory stridor. What condition is most likely?
A) Asthma
B) Pneumonia
C) Upper airway obstruction
D) Pulmonary edema
Answer: C) Upper airway obstruction
Rationale: Inspiratory stridor is a high-pitched sound caused by narrowing of the upper airway, often due to obstruction (e.g., foreign body or edema).
- A patient’s ABG results are: pH 7.48, PaCO2 30 mmHg, HCO3 22 mEq/L, PaO2 85 mmHg. What is the acid-base status?
A) Uncompensated respiratory alkalosis
B) Compensated metabolic acidosis
C) Uncompensated metabolic alkalosis
D) Compensated respiratory alkalosis
Answer: A) Uncompensated respiratory alkalosis
Rationale: The high pH (7.48) and low PaCO2 (30 mmHg) indicate respiratory alkalosis due to hyperventilation. The normal HCO3 (22 mEq/L) shows no compensation, confirming uncompensated respiratory alkalosis.
- A 3-year-old child presents with a barking cough and inspiratory stridor. What is the most likely diagnosis?
A) Asthma
B) Croup
C) Pneumonia
D) Bronchiectasis
Answer: B) Croup
Rationale: A barking cough and inspiratory stridor in a young child are classic signs of croup, caused by viral inflammation of the upper airway.
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