During a spontaneous breathing trial, a ventilated patient breathes at 32/min with a tidal volume of 250 mL. Using the rapid shallow breathing index (threshold 105), what is the index and what does it predict?

128; weaning likely to fail, continue support

8,000; weaning likely to fail, continue support

7.8; weaning likely to succeed, extubate

128; weaning likely to succeed, extubate

In ARDS the pulmonary oedema is non-cardiogenic. It results mainly from:

Leaky alveolar-capillary membrane

On day 3 after an inferior MI, a 63-year-old man suddenly becomes very breathless with pink frothy sputum. BP is 90/60 mmHg and pulse 118/min. A new loud pansystolic murmur is heard at the apex, radiating to the axilla, with no thrill. The most likely complication is:

Free wall rupture with tamponade

In the universal definition of myocardial infarction, the biomarker criterion is a rise and/or fall of cardiac troponin with at least one value above the:

99th percentile upper reference limit

95th percentile upper reference limit

Upper reference limit for CK-MB

Laboratory's lower limit of detection

Cardiovascular and respiratory nursing

60 M.Sc Nursing Entrance (AIIMS, LBS, PGIMER, JIPMER) practice questions on Cardiovascular and respiratory nursing, part of Medical-Surgical Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
By GOLD criteria, persistent airflow limitation confirming COPD is a post-bronchodilator FEV1/FVC ratio of less than:
1. A0.70
2. B0.90
3. C0.80
4. D0.50
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Answer: A · 0.70
COPD is confirmed by spirometry when the FEV1/FVC ratio stays below 0.70 after a bronchodilator. Testing after a bronchodilator shows that the limitation is not fully reversible, which separates it from asthma. The severity grade is then set by the FEV1 as a percentage of predicted. Symptoms and exacerbation history guide treatment.
- B: 0.90 is above the normal adult ratio.
- C: 0.80 is close to normal and would over-diagnose COPD.
- D: 0.50 is too strict and would miss many patients.
Question 2 · Hard
During a spontaneous breathing trial, a ventilated patient breathes at 32/min with a tidal volume of 250 mL. Using the rapid shallow breathing index (threshold 105), what is the index and what does it predict?
1. A8,000; weaning likely to fail, continue support
2. B128; weaning likely to fail, continue support
3. C7.8; weaning likely to succeed, extubate
4. D128; weaning likely to succeed, extubate
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Answer: B · 128; weaning likely to fail, continue support
The rapid shallow breathing index is respiratory rate divided by tidal volume in litres: 32 / 0.25 = 128 breaths/min/L. A value above 105 predicts failure of weaning, because the patient is taking fast, shallow breaths that fatigue the respiratory muscles. The trial is stopped, the patient rested on support, and causes such as secretions or fluid overload are corrected. The nurse watches for the same pattern clinically.
- A: 8,000 is the minute volume in mL, not the index.
- C: 7.8 comes from dividing tidal volume in mL by the rate.
- D: An index above 105 predicts failure, not success.
Question 3 · Medium
In ARDS the pulmonary oedema is non-cardiogenic. It results mainly from:
1. ALow plasma oncotic pressure
2. BRaised left atrial pressure
3. CBlocked pulmonary lymphatics
4. DLeaky alveolar-capillary membrane
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Answer: D · Leaky alveolar-capillary membrane
Inflammatory injury, from sepsis, pneumonia, aspiration or trauma, damages the alveolar-capillary membrane so that protein-rich fluid leaks into the alveoli. Surfactant is lost and alveoli collapse. Because the leak is not driven by pressure, the pulmonary artery wedge pressure is normal, unlike in cardiogenic oedema. Diuretics therefore do not resolve the problem.
- A: Low oncotic pressure causes oedema without this inflammatory injury.
- B: Raised left atrial pressure causes cardiogenic oedema.
- C: Lymphatic obstruction is not the mechanism of ARDS.
Question 4 · Hard
On day 3 after an inferior MI, a 63-year-old man suddenly becomes very breathless with pink frothy sputum. BP is 90/60 mmHg and pulse 118/min. A new loud pansystolic murmur is heard at the apex, radiating to the axilla, with no thrill. The most likely complication is:
1. AFree wall rupture with tamponade
2. BPost-infarction pericarditis
3. CVentricular septal rupture
4. DPapillary muscle rupture
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Answer: D · Papillary muscle rupture
Sudden pulmonary oedema with a new apical pansystolic murmur radiating to the axilla after MI is acute mitral regurgitation from papillary muscle rupture. Inferior MI is the usual setting, because the posteromedial papillary muscle has a single blood supply from the right coronary artery. Ventricular septal rupture also gives a pansystolic murmur, but it is loudest at the left sternal edge, often with a thrill. Free wall rupture causes sudden tamponade and PEA without a murmur, and pericarditis gives a friction rub and pleuritic pain. This is a surgical emergency.
- A: Free wall rupture causes tamponade and collapse, not a new murmur.
- B: Pericarditis causes a friction rub and pleuritic pain, not acute pulmonary oedema.
- C: Septal rupture causes a harsh murmur at the left sternal edge, often with a thrill.
Question 5 · Easy
In the universal definition of myocardial infarction, the biomarker criterion is a rise and/or fall of cardiac troponin with at least one value above the:
1. A95th percentile upper reference limit
2. BUpper reference limit for CK-MB
3. CLaboratory's lower limit of detection
4. D99th percentile upper reference limit
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Answer: D · 99th percentile upper reference limit
Myocardial injury is defined by a cardiac troponin value above the 99th percentile upper reference limit of a healthy population. Infarction also needs a rising or falling pattern plus clinical evidence of ischaemia, such as symptoms, new ECG changes or imaging. The 99th percentile is used because troponin is very specific for myocardial cells. Serial samples matter, since one raised value alone may reflect chronic injury such as kidney disease.
- A: The 95th percentile is a common statistical cut-off but not the one chosen for troponin.
- B: CK-MB is an older, less specific marker and is not the reference for troponin.
- C: Values just above the detection limit can still be normal for a healthy person.
Question 6 · Medium
A 45-year-old's clinic BP readings are repeatedly about 150/96 mmHg, but his home readings average 122/78 mmHg. Which test best confirms the suspected diagnosis?
1. ARepeat clinic readings next week
2. BTransthoracic echocardiography
3. C24-hour ambulatory BP monitoring
4. DRenal artery Doppler study
Answer and explanation in LearnFree account
Question 7 · Medium
ST elevation in leads I, aVL, V5 and V6 points to infarction of which wall, most often supplied by which artery?
1. AInferior wall; right coronary artery
2. BSeptal wall; posterior descending artery
3. CLateral wall; left circumflex artery
4. DAnterior wall; left anterior descending
Answer and explanation in LearnFree account
Question 8 · Hard
A young woman is brought in after taking many aspirin tablets. ABG: pH 7.42, PaCO2 22 mmHg, HCO3- 14 mEq/L (normal pH 7.35-7.45, PaCO2 35-45, HCO3- 22-26). How is this result interpreted?
1. AMixed respiratory alkalosis and metabolic acidosis
2. BFully compensated respiratory alkalosis
3. CFully compensated metabolic acidosis
4. DA normal acid-base state
Answer and explanation in LearnFree account
Question 9 · Medium
A man recovering from an uncomplicated MI asks when he may resume sexual activity. A practical guide nurses use is that he is ready when he can:
1. ASit out of bed in a chair for 2 hours
2. BBriskly climb two flights of stairs without symptoms
3. CWalk slowly for 100 metres on level ground, pain free
4. DGo for one full week without needing a nitrate
Answer and explanation in LearnFree account
Question 10 · Easy
Standard limb lead II records the electrical difference between which two electrodes?
1. ALeft arm and left leg
2. BLeft leg and the chest
3. CRight arm and left arm
4. DRight arm and left leg
Answer and explanation in LearnFree account
Question 11 · Medium
A smoker's spirometry after bronchodilator shows FEV1/FVC 0.58 and FEV1 42% of predicted. What is his GOLD airflow limitation grade?
1. AGOLD 4, very severe
2. BGOLD 2, moderate
3. CGOLD 3, severe
4. DGOLD 1, mild
Answer and explanation in LearnFree account
Question 12 · Easy
During fluid resuscitation of an adult in shock, what is the minimum urine output that shows adequate kidney perfusion?
1. A2 mL/kg/h
2. B5 mL/kg/h
3. C0.1 mL/kg/h
4. D0.5 mL/kg/h
Answer and explanation in LearnFree account
Question 13 · Easy
In arterial blood gas interpretation, the value that reflects the metabolic (renal) component of acid-base balance is:
1. APaO2
2. BOxygen saturation (SaO2)
3. CPaCO2
4. DBicarbonate (HCO3-)
Answer and explanation in LearnFree account
Question 14 · Medium
During CPR, the monitor shows asystole, confirmed in a second lead and with the gain turned up. Along with continuous compressions, the right next step is:
1. ADeliver a 200 J biphasic shock first
2. BGive atropine 1 mg IV
3. CGive adrenaline 1 mg IV at once
4. DGive amiodarone 300 mg IV
Answer and explanation in LearnFree account
Question 15 · Hard
A 50-year-old with septic shock has pH 7.12, PaCO2 38 mmHg, HCO3- 12 mEq/L (normal pH 7.35-7.45, PaCO2 35-45, HCO3- 22-26). Using Winter's formula, how is this best interpreted?
1. AMetabolic acidosis with a coexisting respiratory alkalosis
2. BPrimary respiratory acidosis with renal compensation
3. CMetabolic acidosis with appropriate respiratory compensation
4. DMetabolic acidosis with a coexisting respiratory acidosis
Answer and explanation in LearnFree account
Question 16 · Medium
Under GINA guidance since 2019, which reliever approach is preferred for adults and adolescents with asthma?
1. AAs-needed low-dose ICS-formoterol
2. BAs-needed salbutamol taken alone
3. CAs-needed ipratropium bromide
4. DRegular oral theophylline
Answer and explanation in LearnFree account
Question 17 · Medium
Which single measure slows the accelerated yearly decline in FEV1 in a smoker with COPD?
1. ALong-term oral corticosteroids
2. BYearly influenza vaccination
3. CRegular inhaled bronchodilators
4. DStopping smoking
Answer and explanation in LearnFree account
Question 18 · Easy
B-type natriuretic peptide (BNP) rises in heart failure. Which cells release it mainly?
1. AThe posterior pituitary gland
2. BThe adrenal cortex in response to renin
3. CVentricular myocytes stretched by volume
4. DJuxtaglomerular cells of the kidney
Answer and explanation in LearnFree account
Question 19 · Medium
A 58-year-old has chest pain at rest with new ST depression in V4-V6. Troponin taken on arrival and 3 hours later rises above the 99th percentile. The diagnosis is:
1. ANSTEMI
2. BStable angina
3. CUnstable angina
4. DSTEMI
Answer and explanation in LearnFree account
Question 20 · Easy
In the 'triangle of safety', an intercostal chest drain for pneumothorax is usually inserted at about the:
1. ASecond intercostal space, midclavicular line
2. BFourth or fifth intercostal space, mid-axillary line
3. CSixth intercostal space, parasternal line
4. DEighth intercostal space, scapular line
Answer and explanation in LearnFree account
Question 21 · Easy
Where is the V1 electrode placed when a 12-lead ECG is recorded?
1. AFourth intercostal space, right sternal border
2. BFifth intercostal space, midclavicular line
3. CSecond intercostal space, right sternal border
4. DFourth intercostal space, left sternal border
Answer and explanation in LearnFree account
Question 22 · Easy
The hallmark of acute respiratory distress syndrome is hypoxaemia that:
1. AOccurs only during sleep
2. BCorrects fully with 2 L/min of nasal oxygen
3. CIs always accompanied by early high PaCO2
4. DPersists despite increasing inspired oxygen
Answer and explanation in LearnFree account
Question 23 · Easy
In an adult over 40 with heart failure, a third heart sound (S3 gallop) heard in early diastole indicates:
1. ARapid filling of a volume-overloaded ventricle
2. BFriction between inflamed pericardial layers
3. CClosure of the aortic and pulmonary valves
4. DAtrial contraction into a stiff ventricle
Answer and explanation in LearnFree account
Question 24 · Easy
In spirometry for suspected asthma in an adult, significant bronchodilator reversibility is an FEV1 increase of at least:
1. A5% and 50 mL
2. B12% and 200 mL
3. C30% and 1 litre
4. D50% and 500 mL
Answer and explanation in LearnFree account
Question 25 · Medium
Two weeks after starting ramipril, a hypertensive patient's serum creatinine rises from 1.1 to 2.4 mg/dL. Which underlying condition does this most suggest?
1. ABilateral renal artery stenosis
2. BEssential hypertension
3. CPrimary hyperaldosteronism
4. DPhaeochromocytoma
Answer and explanation in LearnFree account

35 more Cardiovascular and respiratory nursing questions

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Cardiovascular and respiratory nursing

By GOLD criteria, persistent airflow limitation confirming COPD is a post-bronchodilator FEV1/FVC ratio of less than:

During a spontaneous breathing trial, a ventilated patient breathes at 32/min with a tidal volume of 250 mL. Using the rapid shallow breathing index (threshold 105), what is the index and what does it predict?

In ARDS the pulmonary oedema is non-cardiogenic. It results mainly from:

On day 3 after an inferior MI, a 63-year-old man suddenly becomes very breathless with pink frothy sputum. BP is 90/60 mmHg and pulse 118/min. A new loud pansystolic murmur is heard at the apex, radiating to the axilla, with no thrill. The most likely complication is:

In the universal definition of myocardial infarction, the biomarker criterion is a rise and/or fall of cardiac troponin with at least one value above the:

A 45-year-old's clinic BP readings are repeatedly about 150/96 mmHg, but his home readings average 122/78 mmHg. Which test best confirms the suspected diagnosis?

ST elevation in leads I, aVL, V5 and V6 points to infarction of which wall, most often supplied by which artery?

A young woman is brought in after taking many aspirin tablets. ABG: pH 7.42, PaCO2 22 mmHg, HCO3- 14 mEq/L (normal pH 7.35-7.45, PaCO2 35-45, HCO3- 22-26). How is this result interpreted?

A man recovering from an uncomplicated MI asks when he may resume sexual activity. A practical guide nurses use is that he is ready when he can:

Standard limb lead II records the electrical difference between which two electrodes?

A smoker's spirometry after bronchodilator shows FEV1/FVC 0.58 and FEV1 42% of predicted. What is his GOLD airflow limitation grade?

During fluid resuscitation of an adult in shock, what is the minimum urine output that shows adequate kidney perfusion?

In arterial blood gas interpretation, the value that reflects the metabolic (renal) component of acid-base balance is:

During CPR, the monitor shows asystole, confirmed in a second lead and with the gain turned up. Along with continuous compressions, the right next step is:

A 50-year-old with septic shock has pH 7.12, PaCO2 38 mmHg, HCO3- 12 mEq/L (normal pH 7.35-7.45, PaCO2 35-45, HCO3- 22-26). Using Winter's formula, how is this best interpreted?

Under GINA guidance since 2019, which reliever approach is preferred for adults and adolescents with asthma?

Which single measure slows the accelerated yearly decline in FEV1 in a smoker with COPD?

B-type natriuretic peptide (BNP) rises in heart failure. Which cells release it mainly?

A 58-year-old has chest pain at rest with new ST depression in V4-V6. Troponin taken on arrival and 3 hours later rises above the 99th percentile. The diagnosis is:

In the 'triangle of safety', an intercostal chest drain for pneumothorax is usually inserted at about the:

Where is the V1 electrode placed when a 12-lead ECG is recorded?

The hallmark of acute respiratory distress syndrome is hypoxaemia that:

In an adult over 40 with heart failure, a third heart sound (S3 gallop) heard in early diastole indicates:

In spirometry for suspected asthma in an adult, significant bronchodilator reversibility is an FEV1 increase of at least:

Two weeks after starting ramipril, a hypertensive patient's serum creatinine rises from 1.1 to 2.4 mg/dL. Which underlying condition does this most suggest?