Respiratory Failure, ARDS and Ventilation Practice Questions
15 free Respiratory Failure, ARDS and Ventilation practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
According to ARDS guidelines, which tidal volume is most appropriate?
- A 10-12 mL/kg ideal body weight
- B 8-10 mL/kg ideal body weight
- C 6 mL/kg ideal body weight
- D 12-14 mL/kg ideal body weight
Correct answer: 6 mL/kg ideal body weight
Lung-protective ventilation in ARDS uses a low tidal volume of about 6 mL/kg ideal body weight to reduce ventilator-induced lung injury (VILI).
To reduce lung injury in ARDS, plateau pressure should be limited to which value?
- A < 40 cm H₂O
- B < 30 cm H₂O
- C < 20 cm H₂O
- D < 50 cm H₂O
Correct answer: < 30 cm H₂O
Guidelines recommend a plateau pressure (Pplat) of < 30 cm H₂O when ventilating ARDS patients to minimise alveolar overdistension.
What scenario does a PaO₂/FiO₂ ratio of 120 mmHg with bilateral infiltrates indicate?
- A Mild ARDS
- B Moderate ARDS
- C Severe ARDS
- D Not ARDS
Correct answer: Moderate ARDS
A P/F ratio ≤ 200 mmHg (and >100 mmHg) with bilateral infiltrates indicates moderate ARDS; ≤100 mmHg would suggest severe.
When is prone positioning recommended in the management of ARDS?
- A P/F ratio > 300 in a single ABG only
- B P/F ratio < 150 mmHg in moderate to severe ARDS
- C It is never recommended in any ARDS
- D Only for isolated hypercapnic respiratory failure
Correct answer: P/F ratio < 150 mmHg in moderate to severe ARDS
Guidelines strongly recommend prone positioning for ≥12 hours/day in patients with moderate to severe ARDS (often P/F ratio < 150).
What strategy is recommended for fluid management in ventilator‐associated respiratory failure due to ARDS?
- A Liberal fluid strategy to maximise organ perfusion
- B Conservative fluid strategy to limit pulmonary edema
- C Give fluids without any volume-status assessment
- D Use diuretics alone without monitoring volume status
Correct answer: Conservative fluid strategy to limit pulmonary edema
A conservative fluid management approach is suggested in ARDS to minimise further lung injury and pulmonary edema.
What should be considered as the primary cause when a ventilator displays high peak pressures and low tidal volumes delivered?
- A Increased airway resistance such as bronchospasm or kinked tubing
- B Inadequate set FiO₂ on the ventilator
- C Excessive sedation reducing patient effort
- D Inadequate PEEP for the lung condition
Correct answer: Increased airway resistance such as bronchospasm or kinked tubing
High peak pressure and low delivered volume often signal increased airway resistance or patient-vent mismatch; key initial assessment is airway/bronchospasm.
For a ventilated patient in acute hypercapnic respiratory failure, which ventilator change is most appropriate?
- A Decrease the respiratory rate on the ventilator
- B Increase tidal volume while watching plateau pressure
- C Decrease tidal volume to below 4 mL/kg ideal body weight
- D Remove all PEEP from the ventilator circuit
Correct answer: Increase tidal volume while watching plateau pressure
To correct hypercapnia, increase minute ventilation (either rate or tidal volume) as long as plateau pressures remain safe; this is especially critical in ventilator management.
Which finding is most concerning when monitoring for signs of inadequate oxygenation in respiratory failure?
- A SpO₂ 94% on FiO₂ 0.4
- B PaO₂ 55 mmHg and FiO₂ 0.6
- C Respiratory rate 18/min on ventilator
- D Normal ABGs
Correct answer: PaO₂ 55 mmHg and FiO₂ 0.6
PaO₂ of 55 mmHg on high FiO₂ indicates significant hypoxemia and inadequate gas exchange, requiring ventilatory reassessment.
When a ventilator alarm indicates 'low pressure,' what should be the nurse's first action?
- A Increase the delivered FiO₂ immediately
- B Check the circuit and tracheal tube for disconnection or leak
- C Decrease the set respiratory rate on the ventilator
- D Immediately extubate the patient without assessment
Correct answer: Check the circuit and tracheal tube for disconnection or leak
Low pressure alarms often indicate disconnection or leaks in the ventilator circuit; immediate safety check is essential.
Why is neuromuscular blockade used in a patient with ARDS who has been sedated, paralyzed, and ventilated for 48 hours?
- A It is standard practice for every ventilated patient
- B Early neuromuscular blockade may improve oxygenation in moderate to severe ARDS
- C It reliably reduces the required level of PEEP
- D It permanently prevents the patient from being weaned
Correct answer: Early neuromuscular blockade may improve oxygenation in moderate to severe ARDS
Short‐term neuromuscular blockade (e.g., cisatracurium) early in moderate/severe ARDS may improve oxygenation and outcomes by reducing lung injury from patient effort and ventilator.
What risk may excessive PEEP pose in acute respiratory failure due to ARDS?
- A Consistently improved cardiac output and perfusion
- B Decreased venous return causing hypotension
- C Complete elimination of any need for FiO₂
- D Reliable avoidance of all barotrauma
Correct answer: Decreased venous return causing hypotension
Excessive PEEP can increase intrathoracic pressure, reduce venous return, and cause hypotension; careful titration is needed.
Which sign suggests readiness for extubation in a mechanically ventilated patient recovering from respiratory failure?
- A SpO₂ of 88% while on FiO₂ 0.6
- B Spontaneous tidal volume of about 2 mL/kg with shallow breathing
- C Adequate spontaneous tidal volume, strong cough, stable hemodynamics
- D No spontaneous breathing attempts during the trial
Correct answer: Adequate spontaneous tidal volume, strong cough, stable hemodynamics
Indications of readiness include adequate spontaneous tidal volumes (≈5 mL/kg), effective cough, stable vitals and good oxygenation on moderate settings.
What finding is consistent with 'barotrauma' in a ventilated patient for respiratory failure?
- A Isolated expiratory wheezing on auscultation
- B Subcutaneous emphysema or a pneumothorax on chest x-ray
- C Improved lung compliance and better oxygenation
- D New onset of nasal congestion only
Correct answer: Subcutaneous emphysema or a pneumothorax on chest x-ray
Barotrauma from high ventilator pressures may cause pneumothorax, pneumomediastinum or subcutaneous air; nurse must monitor for signs like sudden desaturation and crepitus.
Which ventilator mode allows the patient some spontaneous breaths but gives mandatory breaths if the patient is not breathing adequately?
- A Volume‐controlled mandatory ventilation only
- B Assist/Control (A/C) mode
- C Pressure‐support only
- D Spontaneous breathing mode only
Correct answer: Assist/Control (A/C) mode
Assist/Control mode allows patient‐initiated breaths and delivers mandatory breaths if the patient fails to initiate, useful in respiratory failure management and transition phases.
Why is permissive hypercapnia sometimes allowed in acute respiratory failure due to ARDS?
- A Lower tidal volumes raise CO₂, so moderate hypercapnia is accepted to protect the lungs
- B It automatically improves cardiac output and perfusion
- C It reliably prevents all oxygenation problems
- D Hypercapnia is considered to have no harmful effects
Correct answer: Lower tidal volumes raise CO₂, so moderate hypercapnia is accepted to protect the lungs
Lung-protective ventilation uses lower tidal volumes; to avoid high pressures, moderate hypercapnia (permissive) may be accepted to reduce ventilator‐induced lung injury.