Ch 32: Acute Respiratory Distress Syndrome (ARDS) Flashcards
What is a sudden and progressive form of acute respiratory failure (ARF) in which the alveolar-capillary membrane becomes damaged and more permeable to intravascular fluid?
acute respiratory distress syndrome (ARDS)
Severe V/Q mismatch and shunting of pulmonary capillary blood result in hypoxemia unresponsive to increasing O2 concentrations.
refractory hypoxemia
reflects the ratio of the patient’s Pa02 to the FIO2 that the patient is receiving
Pa02/FIO2 ratio
As a result of delivering a lower-than-normal low tidal volume ventilation to the patient with ARDS, the PaCO2 level will slowly rise above normal limits.
permissive hypercapnia
A 64-year-old male is admitted to the ICU with a diagnosis of necrotizing pancreatitis. Over the past 12 hours, he has become increasingly hypoxic despite receiving high-flow oxygen via a non-rebreather mask. Chest auscultation reveals crackles bilaterally, and his PaO2/FiO2 ratio is 180. The provider suspects the development of ARDS.
Which of the following best explains the patient’s current condition?
A. Direct injury from the aspiration of gastric contents
B. Indirect injury from systemic inflammatory response
C. Complication of chronic obstructive pulmonary disease
D. Inflammatory infiltration of alveoli caused by a fungal infection
B. Indirect injury from systemic inflammatory response
Rationale: Necrotizing pancreatitis is an example of an indirect injury that can lead to ARDS. The systemic inflammatory response releases mediators into the bloodstream, which then affect the lungs, causing increased capillary permeability and fluid accumulation in the alveoli.
Which patient is at the highest risk for developing ARDS?
A. A 55-year-old with COPD exacerbation
B. A 39-year-old who underwent an elective cholecystectomy
C. A 70-year-old with sepsis from a perforated bowel
D. A 29-year-old recovering from a fractured tibia
C. A 70-year-old with sepsis from a perforated bowel
Rationale: Sepsis from a perforated bowel represents both an indirect injury and systemic infection, placing the patient at the highest risk for ARDS. Sepsis is the most common cause of ARDS, especially when coupled with MODS or abdominal catastrophes like perforation.
What is the most common cause of ARDS?
sepsis
A nurse is caring for a patient who developed ARDS following the aspiration of gastric contents. Which mechanism best explains how this direct lung injury contributes to the development of ARDS?
A. Fluid shifts from the interstitial to intravascular space
B. Surfactant production increases, leading to alveolar hyperinflation
C. The inflammatory response damages alveolar-capillary membranes
D. Alveolar macrophages eliminate the aspirated particles rapidly
C. The inflammatory response damages alveolar-capillary membranes
Rationale: In direct lung injury like aspiration, pathogens or irritants contact lung tissue directly, triggering an inflammatory response. This leads to increased permeability of the alveolar-capillary membrane, allowing fluid and proteins to leak into alveoli—hallmarks of ARDS.
A 60-year-old man with a history of diverticulitis is admitted for a suspected bowel perforation. He becomes febrile, hypotensive, and tachypneic. Labs reveal elevated WBCs and lactic acid levels. Chest x-ray shows bilateral infiltrates.
Which complication is most concerning for this patient?
A. Pulmonary embolism
B. Hospital-acquired pneumonia
C. Atelectasis
D. Acute respiratory distress syndrome
D. Acute respiratory distress syndrome
Rationale: This patient has signs of sepsis from bowel perforation, a common indirect cause of ARDS. Bilateral infiltrates, hypoxia, and the systemic inflammatory state suggest progression toward ARDS, which is more critical and time-sensitive than the other options listed.
Which of the following best describes why the lungs are particularly vulnerable to the effects of circulating inflammatory mediators in systemic illness?
A. The lungs act as a filtration system for blood-borne pathogens and mediators
B. The lungs have a slow metabolic rate, causing delayed immune response
C. The lungs are isolated from systemic circulation under normal conditions
D. Inflammatory mediators selectively bypass pulmonary tissue
A. The lungs act as a filtration system for blood-borne pathogens and mediators
Rationale: The lungs receive the entire cardiac output and act as a natural filter for circulating debris and mediators. This makes them a prime target in systemic inflammation, like in sepsis or MODS, often resulting in ARDS.
A nurse is educating a new ICU nurse on the causes of ARDS. Which of the following examples should the nurse include as a direct cause of ARDS?
A. Sepsis due to urinary tract infection
B. Multiple long bone fractures
C. Aspiration of gastric contents
D. Pancreatitis
C. Aspiration of gastric contents
Rationale: Aspiration is a direct insult to the lung parenchyma. It causes inflammation and fluid accumulation in the alveoli almost immediately. The other options are considered indirect causes that result in systemic inflammation impacting the lungs.
Which best explains why patients with multiple risk factors for ARDS are significantly more likely to develop the syndrome?
A. They are more likely to receive high levels of oxygen therapy
B. The immune system overcompensates, enhancing surfactant levels
C. The accumulation of risk factors intensifies the inflammatory response
D. Coexisting conditions restrict lung expansion, leading to infection
C. The accumulation of risk factors intensifies the inflammatory response
Rationale: Patients with multiple risk factors (e.g., trauma + sepsis + blood transfusions) have heightened and sustained inflammatory responses, significantly increasing the risk of alveolar-capillary damage and development of ARDS.
Which of the following are considered indirect causes of ARDS? (Select all that apply)
A. Near-drowning
B. Sepsis
C. Pancreatitis
D. Smoke inhalation
E. Multiple blood transfusions
B. Sepsis
C. Pancreatitis
E. Multiple blood transfusions
Indirect causes of ARDS originate outside the lungs but affect them via systemic inflammation. These include sepsis, pancreatitis, and multiple transfusions. Near-drowning and smoke inhalation are direct causes since the lungs are immediately impacted.
A 48-year-old female was admitted to the ICU with septic shock. After 24 hours on mechanical ventilation, she is showing signs of worsening oxygenation despite increased FiO₂, bilateral crackles, and a PaO₂/FiO₂ ratio of 150. The healthcare provider suspects she is in the early stage of ARDS.
Which of the following describes the primary pathological event occurring in this stage?
A. Formation of fibrotic scar tissue in alveolar spaces
B. Proliferation of type II alveolar cells and fibroblasts
C. Damage to the alveolar-capillary membrane causing fluid leakage
D. Chronic remodeling of lung parenchyma with collagen deposition
C. Damage to the alveolar-capillary membrane causing fluid leakage
Rationale: In the injury or exudative phase, which occurs within the first 1–7 days (often within 24–48 hours), inflammation increases capillary permeability, causing fluid to leak into the alveoli. This leads to non-cardiogenic pulmonary edema and impaired gas exchange—hallmark features of early ARDS.
A patient is in the reparative (proliferative) phase of ARDS. Which of the following clinical or pathophysiological findings is most consistent with this stage?
A. Restoration of normal lung architecture with minimal residual damage
B. Increased fibroblast activity and thickening of the alveolar membrane
C. Rapid resolution of pulmonary edema and complete normalization of compliance
D. Immediate improvement in oxygenation due to new capillary formation
B. Increased fibroblast activity and thickening of the alveolar membrane
Rationale: During the proliferative phase, inflammatory mediators begin to subside, but fibroblasts and other repair cells proliferate. This can lead to thickened alveolar membranes, worsening lung compliance, and persistent hypoxemia. This phase typically occurs 7 to 14 days after the initial injury.
Which statement best describes the fibrotic phase of ARDS?
A. It is a reversible phase where alveolar edema clears rapidly
B. It is characterized by development of hyaline membranes and alveolar collapse
C. It leads to long-term lung dysfunction due to scarring and fibrosis
D. It occurs before the proliferative phase and marks the onset of inflammation
C. It leads to long-term lung dysfunction due to scarring and fibrosis
Rationale: The fibrotic or fibroproliferative phase is the final stage of ARDS. If lung repair is incomplete, fibrosis and scarring replace healthy tissue. This results in permanent damage, reduced lung compliance, and long-term respiratory issues. It can lead to chronic ARDS or death.
Which finding best indicates that a patient has entered the injury or exudative phase of ARDS?
A. Hypoxemia unresponsive to increasing oxygen levels
B. Development of respiratory acidosis and bradycardia
C. Normal chest X-ray with mild respiratory distress
D. Productive cough with yellow sputum
A. Hypoxemia unresponsive to increasing oxygen levels
Rationale: Refractory hypoxemia is a hallmark of the exudative phase of ARDS. Despite increased oxygen delivery, gas exchange is severely impaired due to alveolar filling, surfactant dysfunction, and V/Q mismatch.
A patient with sepsis is developing ARDS. The nurse notes a rapid respiratory rate and decreased tidal volume. Which acid-base imbalance is expected at this early stage?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic alkalosis
B. Respiratory alkalosis
Rationale: In the early phase of ARDS, stimulation of juxtacapillary (J) receptors triggers hyperventilation, causing CO₂ loss and leading to respiratory alkalosis.
What is the primary role of surfactant in the alveoli?
A. Promotes mucus clearance and humidifies air
B. Destroys bacteria that enter the lung
C. Reduces surface tension to prevent alveolar collapse
D. Enhances carbon dioxide transport across membranes
C. Reduces surface tension to prevent alveolar collapse
Rationale: Surfactant, produced by alveolar type II cells, maintains alveolar stability by reducing surface tension. In ARDS, surfactant is decreased or dysfunctional, leading to atelectasis.
A 56-year-old male admitted with pancreatitis is now hypoxic with bilateral infiltrates on CXR. Despite receiving 100% FiO₂, his PaO₂ remains low. What is the underlying mechanism of this hypoxemia?
A. Central hypoventilation
B. Recurrent pulmonary embolism
C. Pulmonary shunt and V/Q mismatch
D. Bronchoconstriction from asthma exacerbation
C. Pulmonary shunt and V/Q mismatch
Rationale: In the exudative phase, fluid-filled alveoli prevent gas exchange despite perfusion, causing shunting. V/Q mismatch further worsens oxygenation, leading to refractory hypoxemia.
Which structural lung damage contributes to decreased lung compliance in the injury phase of ARDS?
A. Damage to type II alveolar cells and loss of surfactant
B. Pleural effusion and rib fractures
C. Enlargement of alveoli and bronchodilation
D. Bronchial wall thickening and airway edema
A. Damage to type II alveolar cells and loss of surfactant
Rationale: Type II alveolar cells produce surfactant. When damaged, surfactant levels drop, leading to increased alveolar surface tension, collapse (atelectasis), and stiff lungs.
Which complication in the injury phase of ARDS contributes most to increased work of breathing (WOB)?
A. Elevated pH
B. Bronchodilation
C. Reduced lung compliance
D. Hyperkalemia
C. Reduced lung compliance
Rationale: The stiff, non-compliant lungs in ARDS make inhalation more difficult. The patient must generate higher airway pressures, increasing work of breathing significantly.
Which hemodynamic response occurs early in the exudative phase as a compensatory mechanism for hypoxemia?
A. Decreased cardiac output
B. Pulmonary hypertension
C. Increased cardiac output
D. Bradycardia
C. Increased cardiac output
Rationale: To compensate for tissue hypoxia, the body initially increases cardiac output to deliver more oxygenated blood, even though pulmonary oxygenation is impaired.
What causes diffusion impairment in ARDS during the injury phase?
A. Pulmonary emboli obstructing the capillaries
B. Formation of thick hyaline membranes
C. Increased alveolar surface area
D. Alveolar overdistension from hyperinflation
B. Formation of thick hyaline membranes
Rationale: Hyaline membranes form from necrotic debris, fibrin, and protein. These thicken the alveolar-capillary barrier, hindering gas diffusion and worsening hypoxemia.
What is the main reason mechanical ventilation becomes necessary in the exudative phase of ARDS?
A. To remove secretions and prevent aspiration
B. To prevent CO₂ retention from hypoventilation
C. To deliver bronchodilators directly to the lungs
D. To provide positive pressure to keep alveoli open
D. To provide positive pressure to keep alveoli open
Rationale: With alveolar collapse from loss of surfactant, positive pressure ventilation helps reopen and stabilize alveoli to improve oxygenation.
Which of the following are direct results of neutrophil activation in the lungs during the exudative phase? (Select all that apply.)
A. Formation of microemboli
B. Surfactant production increase
C. Increased capillary permeability
D. Alveolar hemorrhage
A. Formation of microemboli
C. Increased capillary permeability
Rationale: Neutrophils release mediators that increase capillary permeability and contribute to microemboli formation, worsening lung injury.
Why does the patient initially present with tachypnea in the exudative phase?
A. Compensation for metabolic alkalosis
B. Stimulation of the brainstem by fever
C. Activation of J receptors due to stiff lungs
D. Hypersecretion of mucus from inflammation
C. Activation of J receptors due to stiff lungs
Rationale: J receptors located in the lung parenchyma are stimulated by fluid accumulation and decreased compliance, causing tachypnea.
Which of the following accurately describes a classic clinical sign of ARDS in the exudative phase?
A. SpO₂ increases rapidly with nasal cannula
B. Crackles clear with coughing
C. The patient experiences severe wheezing
D. Hypoxemia does not improve with oxygen
D. Hypoxemia does not improve with oxygen
Rationale: This is known as refractory hypoxemia, where increasing FiO₂ does not improve oxygenation due to severe shunting and V/Q mismatch.
Which type of alveolar cell is primarily responsible for surfactant production?
A. Type I pneumocytes
B. Type II pneumocytes
C. Goblet cells
D. Clara cells
B. Type II pneumocytes
Rationale: Type II alveolar cells synthesize surfactant. In ARDS, damage to these cells leads to surfactant dysfunction and widespread atelectasis.
What role does protein and fibrin leakage into alveoli play during the injury phase?
A. They attract eosinophils to destroy pathogens
B. They block airways and improve ventilation
C. They contribute to hyaline membrane formation
D. They facilitate surfactant synthesis
C. They contribute to hyaline membrane formation
Rationale: Protein and fibrin combine with necrotic debris to form hyaline membranes, worsening alveolar collapse and gas exchange.
A patient is showing signs of increased respiratory effort, bilateral infiltrates, and worsening hypoxemia. What should the nurse anticipate?
A. Decreasing ventilator settings
B. Administering IV furosemide
C. Preparing for intubation and mechanical ventilation
D. Positioning the patient flat for comfort
C. Preparing for intubation and mechanical ventilation
Rationale: As ARDS progresses and lungs become stiffer, the work of breathing increases, and mechanical ventilation is often required to support oxygenation.
What early respiratory pattern is often observed in ARDS during the exudative phase?
A. Bradypnea with increased tidal volume
B. Eupnea with deep sighs
C. Apnea followed by gasping
D. Tachypnea with shallow breathing
D. Tachypnea with shallow breathing
Rationale: In response to J receptor stimulation and hypoxia, the patient develops tachypnea with a reduced tidal volume.
What initiates alveolar-capillary membrane damage in ARDS?
A. Overuse of diuretics and immune response
B. Overexpansion of alveoli and immune response
C. Activation of the inflammatory and immune response
D. Dehydration of alveolar tissues and immune response
C. Activation of the inflammatory and immune response
Rationale: Neutrophils and other immune cells release cytokines and mediators, leading to capillary membrane damage and fluid leakage into alveoli.
Why does surfactant dysfunction contribute to refractory hypoxemia?
A. It leads to CO₂ retention
B. It prevents alveolar overinflation
C. It causes alveoli to collapse, worsening shunt
D. It increases mucus production in alveoli
C. It causes alveoli to collapse, worsening shunt
Rationale: Without surfactant, alveoli collapse, leading to areas that are perfused but not ventilated (shunt), making oxygen therapy less effective.
How does ARDS affect pulmonary blood flow during the injury phase?
A. Causes vasodilation of pulmonary arteries
B. Reduces perfusion to healthy alveoli
C. Enhances capillary exchange of gases
D. Causes vasoconstriction and microemboli formation
D. Causes vasoconstriction and microemboli formation
Rationale: Neutrophil activation and inflammation promote vasoconstriction and microemboli, impairing perfusion and worsening oxygenation.
Which sign indicates failure of compensatory mechanisms in the exudative phase?
A. PaCO₂ below 35 mmHg
B. Hypoventilation with decreased cardiac output
C. SpO₂ greater than 95%
D. Elevated respiratory rate with normal ABGs
B. Hypoventilation with decreased cardiac output
Rationale: As ARDS worsens, compensation fails, leading to hypoventilation, decreased cardiac output, and impaired tissue oxygenation.
A nurse is caring for a patient in the proliferative phase of ARDS. Which finding best explains the continued hypoxemia despite oxygen therapy?
A. Intrapulmonary hemorrhage
B. Loss of lung compliance
C. Destruction of alveolar capillary membrane
D. Thickened alveolar membrane and shunting
D. Thickened alveolar membrane and shunting
Rationale: During the proliferative phase, the alveolar membrane becomes fibrotic and thickened, impairing diffusion. V/Q mismatch and shunting continue, leading to persistent hypoxemia.
Which of the following best describes a major vascular complication that may arise during the proliferative phase of ARDS?
A. Increased left atrial preload
B. Pulmonary hypertension
C. Systemic hypotension
D. Coronary vasoconstriction
B. Pulmonary hypertension
Rationale: Fibroblast activity and ongoing inflammation destroy the pulmonary vasculature, increasing pulmonary vascular resistance and potentially leading to pulmonary hypertension.
What is the primary cause of decreased lung compliance in the proliferative phase of ARDS?
A. Mucus plugging of major airways
B. Fluid retention in alveoli
C. Interstitial fibrosis
D. Bronchial smooth muscle contraction
C. Interstitial fibrosis
Rationale: Fibroblasts produce collagen and fibrous tissue, leading to interstitial fibrosis, which stiffens the lungs and decreases compliance.
Which cells are most responsible for the fibrotic changes seen during the proliferative phase?
A. Type I alveolar cells
B. Mast cells
C. Fibroblasts
D. Goblet cells
C. Fibroblasts
Rationale: Fibroblasts are activated during the proliferative phase and lay down fibrous tissue, contributing to lung stiffness and fibrosis.
Which of the following findings most directly reflects increased airway resistance during the proliferative phase?
A. Inspiratory crackles
B. Productive cough with white sputum
C. Loud wheezes heard over all lung fields
D. Use of accessory muscles and prolonged expirations
D. Use of accessory muscles and prolonged expirations
Rationale: Increased secretions and fluid in the airways during this phase contribute to increased airway resistance, often seen as labored breathing and prolonged expiratory effort.
A patient in the proliferative phase of ARDS has worsening oxygenation and pulmonary artery pressures. Which pathologic process is the most likely cause?
A. Capillary rupture from hypertension
B. Collagen deposition and vascular remodeling
C. Coronary artery narrowing
D. Fluid overload and right-sided heart failure
B. Collagen deposition and vascular remodeling
Rationale: Fibroblasts lay down collagen, leading to fibrosis and destruction of pulmonary vasculature, which increases pulmonary vascular resistance and pressures.
The proliferative phase of ARDS is said to be complete when which of the following occurs?
A. Lungs are fully re-expanded
B. Normal gas exchange is restored
C. Fibrous tissue replaces diseased lung tissue
D. Alveolar macrophages remove all fluid from alveoli
C. Fibrous tissue replaces diseased lung tissue
Rationale: The end of the proliferative phase is marked by the formation of dense fibrous tissue, replacing injured lung areas.
Which outcome would indicate that the proliferative phase has stopped progressing, and the lungs may begin to recover?
A. Inflammatory cell infiltration decreases
B. Pulmonary arterial pressures rise
C. Dense fibrous bands appear on imaging
D. Ventilatory support requirements increase
A. Inflammatory cell infiltration decreases
Rationale: If the inflammatory response subsides, fibroblast activity declines, and the body may begin to repair tissue rather than form fibrosis.
Which pathophysiologic change in the proliferative phase contributes to V/Q mismatch?
A. Consolidation in dependent lung regions
B. Inflammatory destruction of cilia
C. Uneven perfusion from microemboli
D. Thickening of alveolar membranes and fibrosis
D. Thickening of alveolar membranes and fibrosis
Rationale: Thickened alveolar-capillary membranes and fibrosis impair gas exchange and oxygen diffusion, leading to V/Q mismatch and hypoxemia.
A nurse is reviewing a patient’s ABG and imaging during the proliferative phase of ARDS. What finding best indicates the development of diffusion limitation?
A. Normal PaCO₂ but low PaO₂
B. High PaO₂ with nasal cannula
C. Normal chest x-ray but worsening respiratory rate
D. Low PaO₂ despite increased PEEP and FiO₂
D. Low PaO₂ despite increased PEEP and FiO₂
Rationale: As alveolar membranes thicken and fibrosis develops, oxygen diffusion becomes severely impaired, and refractory hypoxemia persists even with advanced ventilatory support.
A patient with ARDS has entered the fibrotic phase. Which of the following findings is most consistent with this stage?
A. Bronchial hyperreactivity and stridor
B. Reversible atelectasis and surfactant restoration
C. Decreased lung compliance and refractory hypoxemia
D. Fluid-filled alveoli and compensatory tachypnea
C. Decreased lung compliance and refractory hypoxemia
Rationale: In the fibrotic phase, interstitial and alveolar fibrosis reduces lung elasticity, making the lungs stiff and noncompliant. The fibrotic tissue limits gas exchange, contributing to persistent hypoxemia despite oxygen therapy.
Which physiologic change is most directly responsible for persistent hypoxemia in the fibrotic stage of ARDS?
A. Pulmonary edema
B. Scarring and fibrosis of lung interstitium
C. Destruction of alveolar capillaries
D. Bronchial constriction
B. Scarring and fibrosis of lung interstitium
Rationale: Widespread fibrosis causes destruction of the alveolar-capillary membrane, significantly reducing the surface area available for gas exchange and contributing to refractory hypoxemia.
A patient with late-stage ARDS requires increasing ventilatory support. Which pathophysiological change explains their increased work of breathing?
A. Loss of diaphragm function
B. Reduced lung compliance from fibrotic remodeling
C. Fluid accumulation in the pleural space
D. Hyperinflation due to air trapping
B. Reduced lung compliance from fibrotic remodeling
Rationale: In the fibrotic stage, collagen and fibrous tissue replace healthy lung parenchyma, making the lungs stiff. This decreased compliance means the patient must generate higher pressures to ventilate, increasing WOB.
Which of the following best describes the prognostic significance of a patient entering the fibrotic phase of ARDS?
A. Likely full lung recovery with physical therapy
B. Need for corticosteroids to reverse fibrosis
C. Higher mortality and long-term pulmonary dysfunction
D. Development of transient pulmonary embolism
C. Higher mortality and long-term pulmonary dysfunction
Rationale: Patients who progress to the fibrotic phase have poorer outcomes. The structural lung damage often results in long-term impairment and reduced oxygenation capacity, increasing the risk for chronic respiratory failure or death.
Which complication is most associated with vascular changes seen in the fibrotic stage of ARDS?
A. Left ventricular hypertrophy
B. Pulmonary hypertension
C. Coronary vasospasm
D. Systemic hypotension
B. Pulmonary hypertension
Rationale: Fibrotic destruction of the pulmonary vasculature increases vascular resistance, which can lead to pulmonary hypertension—a common complication in this phase of ARDS.
In the ICU, a patient with ARDS is noted to have worsening hypoxemia despite maximal ventilator settings. The provider suspects they’ve entered the fibrotic phase. What diagnostic finding would support this suspicion?
A. ABG showing respiratory alkalosis
B. Chest x-ray showing ground-glass opacities
C. CT scan revealing diffuse fibrosis and scarring
D. Low BNP with clear lung fields
B. Chest x-ray showing ground-glass opacities
Rationale: In the fibrotic phase, imaging like a CT scan often shows diffuse lung scarring and fibrosis, which correlates with decreased compliance and severe, unresponsive hypoxemia.
What is the primary structural change occurring in the lungs during the fibrotic phase of ARDS?
A. Replacement of lung tissue with fibrotic tissue
B. Alveolar collapse due to fluid overload
C. Formation of hyaline membranes
D. Bronchial edema and smooth muscle hypertrophy
A. Replacement of lung tissue with fibrotic tissue
Rationale: During the fibrotic phase, fibroproliferation leads to dense collagen deposition, replacing functional lung tissue and impairing gas exchange permanently.
Which of the following best explains why gas exchange is severely compromised in the fibrotic stage of ARDS?
A. Increased mucous secretions
B. Loss of surfactant production
C. Bronchospasm reducing airflow
D. Scarred interstitial space limiting diffusion
D. Scarred interstitial space limiting diffusion
Rationale: In the fibrotic stage, diffuse interstitial scarring leads to a thickened diffusion barrier, which significantly reduces oxygen exchange and results in persistent, severe hypoxemia.
Which patient is at greatest risk for poor prognosis with ARDS?
A. A patient with mild pulmonary edema resolving within 48 hours
B. A patient who required high-flow nasal cannula for 2 days
C. A patient who has entered the fibrotic phase and developed a pneumothorax
D. A patient who was intubated within 30 minutes of acute respiratory failure
C. A patient who has entered the fibrotic phase and developed a pneumothorax
Rationale: The fibrotic phase is associated with poorer outcomes. Additional complications like pneumothorax further impair oxygenation and make ventilation difficult, increasing mortality risk.
What clinical outcome is most likely in a patient who recovers quickly during the acute phase of ARDS?
A. Chronic lung fibrosis requiring lifelong oxygen therapy
B. Refractory hypoxemia and intubation
C. Pulmonary edema resolution and full lung recovery
D. Pulmonary hypertension requiring vasodilator therapy
C. Pulmonary edema resolution and full lung recovery
Rationale: In patients who recover during the acute (exudative) phase, pulmonary edema can resolve, and the lungs often return to normal function within a week, assuming no other complications.
Which factor most directly contributes to the variability in clinical progression of ARDS among different patients?
A. Type of intubation used during mechanical ventilation
B. Amount of oxygen administered during the early phase
C. Use of corticosteroids during the fibrotic phase
D. Nature and extent of the initial lung injury
D. Nature and extent of the initial lung injury
Rationale: The initial injury’s severity plays a key role in determining the clinical trajectory of ARDS. A more severe or widespread injury is likely to result in greater lung damage and progression to the fibrotic phase.
A patient with ARDS has comorbid liver cirrhosis and diabetes. Which factor is most likely to affect their clinical outcome?
A. Extent of underlying comorbidities
B. Blood pressure management
C. Time of day when treatment was initiated
D. Use of low tidal volume ventilation
A. Extent of underlying comorbidities
Rationale: Comorbid conditions, such as liver disease and diabetes, compromise the immune system and healing capacity, worsening the prognosis and slowing lung recovery in ARDS.
Which intervention has the most potential to positively impact the clinical progression of ARDS?
A. Early recognition and prompt initiation of respiratory support
B. Administering antibiotics only after cultures return
C. Placing the patient in Trendelenburg position
D. Delaying intubation until refractory hypoxemia occurs
A. Early recognition and prompt initiation of respiratory support
Rationale: Timely care, including oxygen therapy or mechanical ventilation, can stabilize gas exchange early and may prevent progression to more severe stages, including the fibrotic phase.
A nurse is caring for two ARDS patients. One patient is recovering quickly, while the other requires prolonged ventilation. Which of the following could explain the difference in clinical progression?
A. Both patients received equal levels of oxygen therapy
B. The slower-recovering patient had delayed treatment and multiple comorbidities
C. The faster-recovering patient had a history of COPD
D. The nurse used the same ventilator settings for both patients
B. The slower-recovering patient had delayed treatment and multiple comorbidities
Rationale: Delayed treatment and the presence of comorbidities (e.g., cardiac, renal, hepatic) negatively affect the healing process, making recovery from ARDS more prolonged and complicated.
A patient developed ARDS secondary to trauma. Despite intensive treatment, the condition has worsened. Which unmodifiable factor might contribute to this progression?
A. Timing of intubation
B. Early fluid resuscitation
C. Ventilator tidal volume
D. Genetic predisposition to ARDS
D. Genetic predisposition to ARDS
Rationale: Although not fully understood, genetic factors can influence the body’s inflammatory and healing responses, potentially making some patients more susceptible to progression or complications of ARDS.
Why is mechanical ventilation often required for extended periods in patients who enter the fibrotic phase of ARDS?
A. To reverse alveolar overdistension
B. To decrease dead space ventilation
C. Because of severely reduced lung compliance
D. To maintain metabolic alkalosis
C. Because of severely reduced lung compliance
Rationale: In the fibrotic stage, dense collagen deposition makes lungs extremely stiff, requiring higher airway pressures to ventilate and often necessitating long-term mechanical support.
A patient is improving after surviving the acute phase of ARDS. What finding would best indicate early recovery?
A. Increased pulmonary vascular resistance
B. Return of refractory hypoxemia
C. Development of interstitial fibrosis
D. Progressive reduction in pulmonary edema
D. Progressive reduction in pulmonary edema
Rationale: Improvement in pulmonary edema suggests resolution of the acute inflammatory process, signaling early recovery and better prognosis in ARDS.
Which of the following is most characteristic of the initial presentation of ARDS?
A. Severe dyspnea and cyanosis
B. Mild dyspnea, tachypnea, and restlessness
C. Diffuse coarse crackles on auscultation
D. Progressive respiratory failure and metabolic acidosis
B. Mild dyspnea, tachypnea, and restlessness
Rationale: The initial presentation of ARDS is often subtle, with symptoms like mild dyspnea, tachypnea, and restlessness. Severe symptoms typically develop after 24 to 72 hours.
A patient with ARDS has mild hypoxemia and respiratory alkalosis initially. What is the most likely cause of these findings?
A. Hypoventilation due to severe fluid accumulation
B. Hyperventilation caused by an early compensatory response
C. Impaired gas exchange and decreased lung compliance
D. Metabolic acidosis from organ failure
B. Hyperventilation caused by an early compensatory response
Rationale: In the early stages of ARDS, hyperventilation occurs as a compensatory response to initial hypoxemia, causing respiratory alkalosis. This is often followed by progressive hypoxemia as the disease progresses.
Which of the following findings is most likely to be seen on a chest x-ray after 72 hours of ARDS progression?
A. Normal lung fields with minimal infiltrates
B. Diffuse and extensive bilateral interstitial and alveolar infiltrates
C. Widespread consolidation with no recognizable air spaces
D. Pleural effusion without infiltrates
B. Diffuse and extensive bilateral interstitial and alveolar infiltrates
Rationale: After 72 hours, a chest x-ray typically reveals diffuse and extensive bilateral infiltrates, indicating the progression of ARDS as fluid accumulates in the lungs.
The PaO2/FIO2 (P/F) ratio is calculated to assess the severity of hypoxemia in ARDS. What P/F ratio would indicate severe ARDS?
A. <100
B. <200
C. <300
D. >400
A. <100
Rationale: A P/F ratio of less than 100 indicates severe ARDS, reflecting significant impairment of oxygenation despite high levels of oxygen delivery.
What is the hallmark characteristic of ARDS that distinguishes it from other forms of respiratory failure?
A. Refractory hypoxemia unresponsive to increasing FIO2
B. Progressive metabolic acidosis
C. Increased tidal volume and reduced work of breathing
D. Severe tachypnea and bradycardia
A. Refractory hypoxemia unresponsive to increasing FIO2
Rationale: Refractory hypoxemia is the hallmark feature of ARDS, where oxygenation continues to deteriorate despite increased FIO2, distinguishing it from other forms of respiratory failure.
A patient with ARDS is developing worsening hypoxemia. Which of the following findings would most likely suggest that respiratory failure is imminent?
A. Tachycardia and mild hypoxemia
B. Cyanosis, diaphoresis, and mental status changes
C. Scattered crackles and normal ABG results
D. Hypercapnia with no change in work of breathing
B. Cyanosis, diaphoresis, and mental status changes
Rationale: Cyanosis, diaphoresis, and mental status changes indicate worsening hypoxemia and respiratory failure, which require immediate intervention.
Which ABG finding is typically seen in ARDS as it progresses into respiratory muscle fatigue?
A. Respiratory acidosis and high CO2
B. Respiratory alkalosis and low CO2
C. Metabolic acidosis with compensatory respiratory alkalosis
D. Increased pH with normal CO2 levels
A. Respiratory acidosis and high CO2
Rationale: As ARDS progresses, respiratory muscle fatigue leads to hypoventilation, causing respiratory acidosis with an increase in CO2 levels due to impaired gas exchange.
Which of the following lung auscultation findings is most typical as ARDS progresses?
A. Normal lung sounds with occasional wheezing
B. Diminished breath sounds and dullness to percussion
C. Bronchial breath sounds with pleural friction rubs
D. Fine, scattered crackles that progress to coarse crackles on expiration
D. Fine, scattered crackles that progress to coarse crackles on expiration
Rationale: As ARDS progresses, lung auscultation will show fine, scattered crackles that later become coarse crackles, reflecting the accumulation of fluid in the alveoli and airways.
A nurse is assessing a patient with ARDS and notices intercostal and suprasternal retractions. What does this finding indicate?
A. Severe pulmonary edema and increased work of breathing
B. Decreased lung compliance and early compensatory mechanisms
C. Complete lung collapse and impending respiratory failure
D. Improvement in ventilation and oxygenation status
A. Severe pulmonary edema and increased work of breathing
Rationale: Intercostal and suprasternal retractions are signs of increased work of breathing due to severe pulmonary edema and reduced lung compliance, indicating worsening ARDS.
A patient with ARDS has a P/F ratio of 150. How would the nurse interpret this result?
A. Mild ARDS
B. Moderate ARDS
C. Severe ARDS
D. Normal oxygenation status
B. Moderate ARDS
Rationale: A P/F ratio of 150 indicates moderate ARDS. Mild ARDS would have a ratio of 200-300, while severe ARDS would have a ratio of less than 100.
What is the significance of the chest x-ray appearance described as “whiteout” in ARDS?
A. Indicates complete alveolar collapse and poor prognosis
B. Represents widespread consolidation and loss of recognizable air spaces
C. Suggests resolution of pulmonary edema and improvement in oxygenation
D. Confirms the presence of pleural effusions without ARDS
B. Represents widespread consolidation and loss of recognizable air spaces
Rationale: The term “whiteout” refers to widespread consolidation and loss of air spaces due to severe pulmonary edema in ARDS, confirming progression of the disease.
A patient with ARDS has increasing pleural effusions. What is the most likely cause of this complication?
A. Pulmonary hypertension from impaired oxygenation
B. Widespread consolidation and alveolar damage
C. Decreased surfactant production and alveolar collapse
D. Increased capillary permeability and fluid leakage into the pleural space
D. Increased capillary permeability and fluid leakage into the pleural space
Rationale: Increased capillary permeability in ARDS leads to the leakage of fluid into the pleural space, resulting in pleural effusions.
What finding on an ABG would most likely suggest that respiratory failure is imminent in ARDS?
A. Mild hypoxemia and respiratory alkalosis
B. Respiratory acidosis with high PaCO2 and low pH
C. Metabolic alkalosis and a normal PaCO2
D. Mild hypercapnia and normal pH levels
B. Respiratory acidosis with high PaCO2 and low pH
Rationale: Respiratory acidosis with high PaCO2 and a low pH signals severe ventilation failure and impending respiratory failure as the patient is unable to compensate for hypoventilation.
A nurse is caring for a patient with ARDS and observes that the patient is becoming progressively more tachypneic and exhibits suprasternal retractions. What does this finding suggest?
A. The patient’s respiratory status is improving.
B. The patient’s condition has progressed to metabolic acidosis.
C. The patient is compensating well for the hypoxemia
D. The patient is experiencing severe respiratory distress.
D. The patient is experiencing severe respiratory distress.
Rationale: Suprasternal retractions indicate that the patient is in severe respiratory distress and struggling to breathe effectively. This sign suggests worsening ARDS with increased work of breathing.
A patient with ARDS has an increasing PaCO2 level and a decreasing PaO2. What is the most likely explanation for this progression?
A. The patient is developing respiratory failure due to muscle fatigue.
B. The patient is compensating for metabolic acidosis.
C. The patient is in the resolution phase of ARDS.
D. The patient is experiencing compensatory hypoventilation.
A. The patient is developing respiratory failure due to muscle fatigue.
Rationale: Increasing PaCO2 and decreasing PaO2 typically indicate respiratory failure due to respiratory muscle fatigue in ARDS, where the lungs are unable to provide adequate oxygenation and ventilation.
Which of the following is the most significant factor in determining the clinical course and outcome of ARDS?
A. The speed at which mechanical ventilation is initiated
B. The type of initial injury and extent of lung damage
C. The patient’s genetic predisposition to ARDS
D. The presence of comorbidities such as diabetes
B. The type of initial injury and extent of lung damage
Rationale: The type of initial injury (e.g., trauma, aspiration, pneumonia) and the extent of lung damage are the most significant factors influencing the clinical course and outcome of ARDS. Early and appropriate intervention is crucial to improving survival rates.
A nurse is reviewing the chest x-ray of a patient with ARDS. The x-ray reveals bilateral interstitial infiltrates and extensive alveolar damage. What stage of ARDS is the patient most likely in?
A. Initial injury phase
B. Fibrotic (chronic) phase
C. Exudative (acute) phase
D. Recovery phase
C. Exudative (acute) phase
Rationale: The presence of bilateral interstitial infiltrates and alveolar damage on a chest x-ray suggests that the patient is in the exudative (acute) phase of ARDS, where inflammatory changes lead to fluid accumulation and impaired gas exchange.
A patient with ARDS develops multiple organ dysfunction syndrome (MODS) and is suspected of having sepsis. What is the primary cause of death in patients with ARDS?
A. Progressive hypoxemia
B. Renal failure
C. Multiple organ dysfunction syndrome
D. Pneumothorax
C. Multiple organ dysfunction syndrome
Rationale: The primary cause of death in ARDS patients is MODS, often accompanied by sepsis. This systemic complication leads to failure of multiple vital organs, including the kidneys, liver, and heart.
A nurse is caring for a patient with ARDS who is receiving mechanical ventilation. The nurse should monitor for complications related to the treatment of ARDS. Which complication is most commonly associated with mechanical ventilation?
A. Hyperglycemia
B. Pneumothorax
C. Gastrointestinal bleeding
D. Renal failure
B. Pneumothorax
Rationale: Pneumothorax is a common complication of mechanical ventilation in patients with ARDS, due to increased airway pressures or barotrauma. This can lead to further deterioration in respiratory function.
A patient with ARDS is experiencing sepsis and is at risk for developing multiple organ dysfunction syndrome (MODS). What is the most important intervention to prevent further complications in this patient?
A. Administering vasopressors to maintain blood pressure
B. Monitoring for signs of systemic infection and treating with antibiotics
C. Starting corticosteroid therapy to reduce inflammation
D. Limiting fluid intake to prevent fluid overload
B. Monitoring for signs of systemic infection and treating with antibiotics
Rationale: In patients with ARDS, sepsis is a common cause of MODS. Early detection and treatment of systemic infection with antibiotics is essential to prevent worsening organ dysfunction and improve survival outcomes.
A nurse is assessing a patient who recently recovered from ARDS. The patient reports persistent shortness of breath after minimal activity. Which factor most likely contributes to the patient’s ongoing symptoms?
A. Complete resolution of lung injury
B. Recent initiation of mechanical ventilation
C. Full recovery of normal lung function
D. Persistent scarring and fibrosis in the lungs
D. Persistent scarring and fibrosis in the lungs
Rationale: Persistent scarring and fibrosis in the lungs are common in ARDS survivors, contributing to ongoing symptoms such as shortness of breath, fatigue, and dyspnea, even after recovery. Scarring may impact lung function for years.
Which factor is most likely to impact the long-term recovery of lung function in a patient who has survived ARDS?
A. Early initiation of mechanical ventilation
B. Short duration of mechanical ventilation
C. Use of extracorporeal life support during the acute phase
D. Severity of the initial lung injury and extent of scarring
D. Severity of the initial lung injury and extent of scarring
Rationale: The severity of the initial lung injury and the extent of scarring are key factors in long-term lung function recovery. Mechanical ventilation and extracorporeal life support may contribute to recovery, but the degree of lung injury and fibrosis plays a significant role.
A patient who has recovered from ARDS continues to experience persistent dyspnea and fatigue. Which of the following interventions would best help manage these symptoms in the long term?
A. Increasing physical activity to improve lung capacity
B. Recommending long-term corticosteroid therapy
C. Encouraging the patient to use supplemental oxygen during exertion
D. Prescribing bronchodilators for symptom relief
C. Encouraging the patient to use supplemental oxygen during exertion
Rationale: Patients with persistent dyspnea and fatigue after ARDS may benefit from supplemental oxygen during exertion, which can help improve oxygenation and alleviate symptoms. Long-term management focuses on optimizing function and managing symptoms, not over-reliance on medications.
A patient recovering from ARDS is concerned about the potential for long-term lung function impairment. Which of the following statements is true regarding long-term recovery after ARDS?
A. Most patients will regain normal lung function within weeks of recovery.
B. Persistent abnormal lung function can last for years, with some patients having lifelong impairment.
C. The use of mechanical ventilation ensures complete recovery of lung function.
D. Patients who survive ARDS generally do not experience any long-term lung function issues.
B. Persistent abnormal lung function can last for years, with some patients having lifelong impairment.
Rationale: While some patients may recover normal lung function, persistent abnormal lung function can last for years or may even result in lifelong impairment due to scarring and fibrosis in the lungs. Mechanical ventilation and extracorporeal life support can also contribute to long-term changes.
Which of the following is a common symptom reported by patients after recovering from ARDS?
A. Chest pain, shortness of breath, and fatigue after minimal activity
B. Absent breath sounds
C. High-grade fever and chills
D. Sudden onset of severe dyspnea at rest
A. Chest pain, shortness of breath, and fatigue after minimal activity
Rationale: Many ARDS survivors report persistent chest pain, shortness of breath, and fatigue after minimal activity due to residual lung damage and scarring. These symptoms are common long-term effects following the resolution of the acute phase.
A nurse is educating a patient who is recovering from ARDS. Which of the following statements by the patient indicates a need for further education about long-term lung function?
A. “I understand that I may experience some shortness of breath for months or years.”
B. “I may continue to feel fatigued after minimal physical activity.”
C. “Persistent chest pain and breathlessness are common after recovery.”
D. “I should expect my lung function to return to normal in the next few weeks.”
D. “I should expect my lung function to return to normal in the next few weeks.”
Rationale: This statement reflects an unrealistic expectation of immediate recovery. While some patients may regain near-normal lung function, others experience persistent symptoms, and it can take months to years for full recovery, if at all. Education should emphasize the possibility of long-term symptoms.
A 58-year-old male patient with chronic obstructive pulmonary disease (COPD) is admitted to the ICU following a motor vehicle accident. He is placed on mechanical ventilation and receives enteral nutrition (EN) through a nasogastric tube. On day 5 of mechanical ventilation, he develops a fever, increased sputum production, and a new infiltrate on his chest x-ray. His nurse is concerned about the possibility of ventilator-associated pneumonia (VAP).
What is the most likely cause of his condition?
A) Aspiration due to enteral nutrition
B) Mechanical ventilation over a short period
C) Worsening of his chronic obstructive pulmonary disease (COPD)
D) Use of a non-invasive positive pressure ventilation device
A) Aspiration due to enteral nutrition
Rationale: Patients receiving enteral nutrition (EN) are at higher risk for aspiration, which is one of the risk factors for VAP. Aspiration can introduce bacteria into the lungs, leading to infection and the development of VAP.
A nurse is caring for a mechanically ventilated patient in the ICU who has been on the ventilator for 10 days. The patient is receiving enteral nutrition (EN) and is at risk for ventilator-associated pneumonia (VAP). Which of the following interventions would be most effective in reducing the risk of VAP?
A) Frequent suctioning of the airway
B) Implementing a ventilator bundle protocol
C) Increasing the patient’s sedation levels
D) Administering broad-spectrum antibiotics
B) Implementing a ventilator bundle protocol
Rationale: A ventilator bundle protocol, which includes evidence-based practices such as elevating the head of the bed, oral care, and appropriate sedation management, is effective in reducing the incidence of VAP in mechanically ventilated patients.
A nurse is reviewing the medical records of a mechanically ventilated patient who has been on the ventilator for 12 days. The patient is at high risk for ventilator-associated pneumonia (VAP). Which of the following risk factors should the nurse consider when assessing the patient’s likelihood of developing VAP?
A) Prolonged mechanical ventilation
B) Non-invasive ventilation use
C) Decreased oral hygiene
D) Low FiO2 (fraction of inspired oxygen) levels
A) Prolonged mechanical ventilation
Rationale: Prolonged mechanical ventilation is a key risk factor for VAP. Longer durations of ventilation increase the likelihood of ventilator-associated infections due to impaired host defenses and the use of invasive devices.
A 65-year-old patient who underwent abdominal surgery is placed on mechanical ventilation in the ICU. He has been on the ventilator for 7 days and is receiving enteral nutrition (EN). The nurse is concerned about the patient developing ventilator-associated pneumonia (VAP). Which of the following actions should the nurse prioritize to reduce the patient’s risk?
A) Ensuring the patient remains in a supine position
B) Providing frequent oral care with chlorhexidine
C) Administering sedatives every 2 hours to ensure comfort
D) Decreasing the amount of enteral nutrition
B) Providing frequent oral care with chlorhexidine
Rationale: Providing frequent oral care with chlorhexidine has been shown to reduce the incidence of VAP by minimizing the buildup of bacterial pathogens in the mouth, which can be aspirated into the lungs.
A 68-year-old male patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation. The healthcare team is concerned about the risk of barotrauma due to the high peak airway pressures required for ventilation. Which intervention is most effective in reducing the risk of barotrauma for this patient?
A) Increasing the tidal volume (VT) to 10 mL/kg
B) Using a higher level of positive end-expiratory pressure (PEEP)
C) Administering higher levels of sedation to reduce ventilator synchrony
D) Providing ventilation with a smaller tidal volume (VT) of 4 to 8 mL/kg
D) Providing ventilation with a smaller tidal volume (VT) of 4 to 8 mL/kg
Rationale: Using a smaller tidal volume of 4 to 8 mL/kg reduces the risk of overdistending the fragile alveoli, which can prevent barotrauma. This approach minimizes the chance of lung injury and complications such as pneumothorax and subcutaneous emphysema.
A 54-year-old patient with ARDS has been placed on mechanical ventilation for 5 days. The patient begins to show signs of a pneumothorax, including decreased breath sounds on one side, hypotension, and tachypnea. Which of the following is most likely the cause of the pneumothorax in this patient?
A) Ventilation with excessive tidal volume (VT)
B) Insufficient sedation during mechanical ventilation
C) Low levels of positive end-expiratory pressure (PEEP)
D) Prolonged use of a non-invasive ventilation device
A) Ventilation with excessive tidal volume (VT)
Rationale: Barotrauma, which can cause pneumothorax, is most often a result of excessive tidal volume (VT) or high peak airway pressures. Overdistending the alveoli during mechanical ventilation increases the risk of alveolar rupture and subsequent pneumothorax.
A nurse is caring for a patient with ARDS who is on mechanical ventilation. The healthcare provider adjusts the ventilator settings to use a smaller tidal volume (VT) and lower peak airway pressures. The nurse is monitoring for the potential complications of barotrauma. Which of the following findings would suggest that the patient is experiencing barotrauma?
A) Decreased oxygen saturation and increased PaCO2 levels
B) Decreased breath sounds on one side, hypotension, and tachypnea
C) Increased respiratory rate and non-productive cough
D) Increased sputum production and fever
B) Decreased breath sounds on one side, hypotension, and tachypnea
Rationale: Decreased breath sounds on one side, hypotension, and tachypnea are classic signs of pneumothorax, which is a complication of barotrauma. The rupture of alveoli allows air to escape into the pleural space, leading to a collapsed lung and associated symptoms.
A patient with ARDS is receiving mechanical ventilation with a tidal volume of 10 mL/kg. The healthcare team adjusts the ventilator settings to decrease the tidal volume to 5 mL/kg in an effort to reduce the risk of barotrauma. Which of the following is the primary reason for this adjustment?
A) To increase the patient’s tidal volume and improve oxygenation
B) To minimize the risk of overdistending fragile alveoli and causing lung injury
C) To reduce the need for positive end-expiratory pressure (PEEP)
D) To increase the patient’s comfort and synchrony with the ventilator
B) To minimize the risk of overdistending fragile alveoli and causing lung injury
Rationale: Decreasing the tidal volume reduces the risk of overdistending fragile alveoli, which can prevent barotrauma. Smaller tidal volumes help minimize the risk of ventilator-associated lung injury, including complications like pneumothorax and subcutaneous emphysema.
A patient with acute respiratory failure (ARF) and acute respiratory distress syndrome (ARDS) is at high risk for gastrointestinal (GI) ulcers. Which of the following management strategies is most appropriate to prevent GI ulcers in this patient?
A) Administering large doses of corticosteroids
B) Discontinuing mechanical ventilation as soon as possible
C) Correcting predisposing conditions, such as hypotension and acidosis
D) Providing total parenteral nutrition (TPN) instead of enteral nutrition
C) Correcting predisposing conditions, such as hypotension and acidosis
Rationale: Correcting predisposing conditions, such as hypotension, shock, and acidosis, is essential to prevent GI ulcers. Adequate perfusion to the GI system is necessary to prevent ischemic damage that can lead to ulcers. Prophylactic treatment and enteral nutrition are also important.
A 72-year-old patient with ARDS and a history of hypotension is at risk for developing GI ulcers. The healthcare provider orders prophylactic treatment. Which of the following medications should the nurse anticipate being ordered to help prevent ulcer formation?
A) Pantoprazole
B) Dexamethasone
C) Furosemide
D) Nitroglycerin
A) Pantoprazole
Rationale: Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid secretion, helping to prevent GI ulcers. PPIs are commonly used for prophylactic ulcer management in critically ill patients, particularly those with ARDS and ARF.
A patient with ARDS is receiving enteral nutrition (EN) to prevent mucosal damage. Which of the following is the primary benefit of early enteral nutrition in this patient?
A) It decreases the risk of aspiration pneumonia
B) It reduces the risk of developing GI ulcers
C) It improves oxygenation and ventilation
D) It enhances the absorption of medications
B) It reduces the risk of developing GI ulcers
Rationale: Early enteral nutrition helps maintain mucosal integrity in the gastrointestinal system, reducing the risk of GI ulcers in critically ill patients. It supports the gut’s function, preventing ischemic damage due to inadequate blood flow.
A patient with ARDS and shock is receiving antiulcer prophylaxis. The nurse is monitoring for potential adverse effects of the prescribed pantoprazole. Which of the following adverse effects is most commonly associated with proton pump inhibitors like pantoprazole?
A) Hyperkalemia with long-term use
B) Hypocalcemia with long-term use
C) Osteoporosis with long-term use
D) Hypotension with long-term use
C) Osteoporosis with long-term use
Rationale: Long-term use of proton pump inhibitors (PPIs) like pantoprazole can increase the risk of osteoporosis, particularly in patients who require prolonged therapy. PPIs reduce gastric acid secretion, which can impair calcium absorption and contribute to bone weakening over time.
A nurse is caring for a patient with ARDS and ARF who is at high risk for GI ulcers. The healthcare provider has ordered a proton pump inhibitor (PPI) and sucralfate. The nurse is preparing to administer both medications. What is the primary purpose of sucralfate in this patient’s treatment plan?
A) To reduce gastric acid secretion
B) To protect the mucosal lining of the GI tract
C) To promote gastric motility
D) To increase gastric acid production
B) To protect the mucosal lining of the GI tract
Rationale: Sucralfate is a mucosal-protecting drug that forms a protective barrier over ulcerated areas in the GI tract, helping to prevent further damage. This is particularly important in patients at risk for GI ulcers, such as those with ARDS and ARF.
A nurse is caring for a patient with ARDS who is at high risk for venous thromboembolism (VTE) due to immobility and venous stasis. Which of the following interventions is most appropriate for this patient to help prevent deep vein thrombosis (DVT)?
A) Administering aspirin
B) Applying intermittent pneumatic compression stockings
C) Restricting fluid intake
D) Encouraging prolonged bed rest
B) Applying intermittent pneumatic compression stockings
Rationale: Intermittent pneumatic compression stockings help prevent DVT by promoting circulation and preventing venous stasis. This is especially important in critically ill patients, such as those with ARDS, who are immobile and at higher risk for VTE.
A nurse is caring for a patient with ARDS who is receiving anticoagulation therapy for the prevention of venous thromboembolism (VTE). The nurse is preparing to administer heparin. Which of the following is the most important assessment prior to administering heparin?
A) Platelet count
B) Serum potassium level
C) Blood pressure
D) Respiratory rate
A) Platelet count
Rationale: Prior to administering heparin, it is essential to assess the platelet count to monitor for potential heparin-induced thrombocytopenia (HIT). Low platelet counts could indicate the development of HIT, a serious complication of anticoagulation therapy.
A patient with ARDS is at high risk for venous thromboembolism (VTE) and has been prescribed early ambulation as part of their prophylactic management plan. Which of the following is the most significant benefit of early ambulation in this patient?
A) It reduces the risk of developing pneumonia
B) It improves oxygenation and ventilation
C) It enhances circulation and reduces venous stasis
D) It promotes lung compliance
C) It enhances circulation and reduces venous stasis
Rationale: Early ambulation helps to enhance circulation and reduce venous stasis, which is a key factor in preventing venous thromboembolism (VTE). This is especially important for patients with ARDS, who are often immobile and at increased risk for DVT and pulmonary embolism.
A patient with ARDS is at risk for acute kidney injury (AKI) due to hypotension and hypoxemia. Which of the following is the most appropriate nursing intervention for monitoring kidney function in this patient?
A) Monitoring the patient’s blood pressure every hour
B) Monitoring daily creatinine and urea levels
C) Administering intravenous fluids aggressively
D) Restricting fluid intake to prevent overload
B) Monitoring daily creatinine and urea levels
Rationale: Monitoring creatinine and urea levels is crucial to assess kidney function in patients at risk for AKI. This helps in early detection of renal impairment, which is especially important in patients with ARDS.
A patient with ARDS is receiving continuous renal replacement therapy (CRRT). The nurse understands that CRRT is preferred over traditional hemodialysis in this patient because:
A) It is faster than traditional hemodialysis
B) It requires fewer nursing interventions
C) The patient can tolerate larger fluid volumes with CRRT
D) It is slower and gentler, which is better tolerated in hemodynamically unstable patients
D) It is slower and gentler, which is better tolerated in hemodynamically unstable patients
Rationale: CRRT is slower and gentler than traditional hemodialysis, which is particularly beneficial for patients who are hemodynamically unstable, as they cannot tolerate the large fluid shifts and volumes removed by conventional dialysis.
A nurse is caring for a patient with ARDS who is receiving CRRT due to acute kidney injury (AKI). The patient is also on vasopressors to maintain blood pressure. Which of the following is the most important assessment before initiating CRRT in this patient?
A) Serum potassium level
B) Respiratory rate
C) Blood pressure and heart rate
D) Temperature and white blood cell count
C) Blood pressure and heart rate
Rationale: Before initiating CRRT, it is crucial to assess the patient’s blood pressure and heart rate, as CRRT can affect hemodynamic stability. Monitoring these parameters ensures that the patient remains stable while undergoing the therapy, especially since vasopressors are being used.
A nurse is caring for a patient with ARDS who is experiencing acute kidney injury (AKI) due to nephrotoxic drugs used to treat ARDS-related infections. Which of the following nephrotoxic drugs is most commonly associated with AKI in ARDS patients?
A) Vancomycin
B) Furosemide
C) Dexamethasone
D) Metoprolol
A) Vancomycin
Rationale: Vancomycin is a nephrotoxic drug commonly used to treat infections in ARDS patients, and it is associated with an increased risk of acute kidney injury (AKI). Monitoring renal function is crucial in patients receiving this medication.
A nurse is providing care for a patient with ARDS and acute kidney injury (AKI) who is receiving CRRT. Which of the following complications should the nurse be most vigilant for in this patient?
A) Hypokalemia
B) Hyperglycemia
C) Hypotension
D) Hypertension
C) Hypotension
Rationale: Hypotension is a potential complication of CRRT, especially in patients with ARDS and AKI. Since CRRT is a continuous process, it can lead to gradual shifts in fluid and electrolytes, potentially resulting in hypotension.
A patient with ARDS and acute kidney injury (AKI) is being treated with CRRT. The nurse is aware that one of the key benefits of CRRT in this patient is:
A) Faster removal of toxins
B) Maintenance of hemodynamic stability
C) Reduction of electrolyte imbalances
D) Decreased risk of infection
B) Maintenance of hemodynamic stability
Rationale: One of the key benefits of CRRT is its ability to maintain hemodynamic stability in critically ill patients. Unlike traditional hemodialysis, CRRT is slow and continuous, which reduces the risk of sudden fluid shifts that could cause hypotension.
A nurse is monitoring a patient with ARDS who is at risk for developing acute kidney injury (AKI). The patient’s blood pressure is 90/50 mm Hg, and the nurse is concerned about renal perfusion. Which of the following interventions is most appropriate to support renal perfusion in this patient?
A) Administering vasopressors
B) Increasing intravenous fluids rapidly
C) Decreasing vasopressor doses
D) Encouraging the patient to increase fluid intake
A) Administering vasopressors
Rationale: In patients with hypotension, especially those with ARDS and AKI, vasopressors are used to support renal perfusion by raising blood pressure and maintaining adequate blood flow to the kidneys.
A patient with ARDS is being treated with continuous renal replacement therapy (CRRT) for acute kidney injury (AKI). The nurse is aware that the patient is at increased risk for which of the following complications related to CRRT?
A) Hypovolemia
B) Respiratory distress
C) Hypervolemia
D) Hypothermia
A) Hypovolemia
Rationale: CRRT can lead to hypovolemia, especially if fluid removal exceeds the patient’s capacity to compensate. The nurse should monitor the patient for signs of hypovolemia and adjust the CRRT settings as necessary.
A nurse is caring for a patient who survived ARDS and is experiencing symptoms such as anxiety, nightmares, and difficulty concentrating. The nurse suspects the patient may be dealing with posttraumatic stress disorder (PTSD). Which of the following interventions is most appropriate to address the psychological needs of this patient?
A) Encouraging the patient to focus on physical rehabilitation
B) Providing reassurance that these symptoms will resolve on their own
C) Referring the patient for a psychiatric evaluation and therapy
D) Administering a sedative to help manage anxiety
C) Referring the patient for a psychiatric evaluation and therapy
Rationale: Survivors of ARDS may experience symptoms of PTSD, anxiety, and depression. It is essential to refer the patient for a psychiatric evaluation to ensure proper diagnosis and treatment, which may include therapy or counseling, rather than solely relying on medication or physical rehabilitation.
A patient who survived ARDS is expressing feelings of depression and is unable to focus on daily tasks. The nurse understands that which of the following factors is most likely contributing to these symptoms?
A) The physical recovery process from ARDS is complete
B) Psychological issues such as PTSD and depression can persist even after recovery
C) The patient is experiencing a recurrence of ARDS
D) The patient is still experiencing respiratory distress
B) Psychological issues such as PTSD and depression can persist even after recovery
Rationale: Survivors of ARDS often experience long-lasting psychological issues, such as PTSD and depression, which can persist for months or even years after recovery. These mental health issues may hinder their overall recovery process, and addressing them is an essential part of care.
A patient with ARDS is being managed with mechanical ventilation, low tidal volume ventilation, and PEEP. The nurse is monitoring the patient’s hemodynamic status and adjusting medications accordingly. Which of the following medications is most appropriate for maintaining blood pressure in this patient?
A) Norepinephrine
B) Furosemide
C) Lorazepam
D) Dexamethasone
A) Norepinephrine
Rationale: Norepinephrine is a vasopressor used to maintain blood pressure in patients with ARDS who are experiencing hypotension. It helps increase vascular tone and improve perfusion to vital organs. The other medications listed are not appropriate for managing hypotension in this context.
A patient with ARDS is receiving neuromuscular blocking agents to facilitate mechanical ventilation. Which of the following is a priority intervention when administering neuromuscular blocking agents?
A) Monitoring blood glucose levels frequently
B) Ensuring adequate sedation and analgesia
C) Administering a bolus of IV fluids prior to administration
D) Measuring oxygen saturation continuously
B) Ensuring adequate sedation and analgesia
Rationale: Neuromuscular blocking agents are used to paralyze the patient to facilitate mechanical ventilation. It is crucial to ensure that the patient is adequately sedated and receiving analgesia to prevent discomfort and anxiety while paralyzed. Continuous monitoring of oxygen saturation is also important, but sedation and analgesia are the priority.
A nurse is caring for a patient with ARDS who is being treated with ECMO (extracorporeal membrane oxygenation). The nurse is aware that ECMO therapy is most beneficial for which of the following situations?
A) Patients with severe hemodynamic instability despite conventional mechanical ventilation
B) Patients who require short-term oxygen supplementation
C) Patients with low-volume mechanical ventilation needs
D) Patients with mild hypoxemia and low tidal volume ventilation
A) Patients with severe hemodynamic instability despite conventional mechanical ventilation
Rationale: ECMO is a life-saving intervention for patients with ARDS who are severely unstable despite conventional mechanical ventilation. It provides cardiac and respiratory support, improving oxygenation and removing CO2. It is typically not used for mild cases of ARDS or for patients with minimal mechanical ventilation needs.
A patient with ARDS is receiving inotropic drugs, including dobutamine. The nurse is monitoring for potential complications related to the administration of this medication. Which of the following side effects should the nurse prioritize monitoring?
A) Hyperkalemia
B) Hypoglycemia
C) Peripheral edema
D) Tachycardia
D) Tachycardia
Rationale: Dobutamine is an inotropic drug used to improve cardiac output in ARDS patients. It can cause tachycardia as a side effect, which should be closely monitored to prevent further complications such as arrhythmias. The other side effects listed are not as closely associated with dobutamine use.
A nurse is caring for a patient with ARDS who is being administered IV fluids on the “dry side.” The nurse understands that this approach is used to:
A) Prevent fluid overload and reduce pulmonary edema
B) Ensure adequate hydration for kidney function
C) Increase circulating blood volume during hypotension
D) Promote weight gain and tissue repair
A) Prevent fluid overload and reduce pulmonary edema
Rationale: In ARDS management, maintaining the patient on the “dry side” means restricting fluid intake to prevent fluid overload and reduce the risk of worsening pulmonary edema. This strategy is essential to optimize oxygenation and prevent further complications.
A nurse is educating a patient with ARDS about the importance of nutrition therapy. Which of the following is a key component of nutrition management in ARDS?
A) Starting enteral nutrition as soon as possible
B) Encouraging high-protein, low-fat meals
C) Avoiding all forms of nutrition support to prevent aspiration
D) Limiting oral intake to prevent nausea and vomiting
A) Starting enteral nutrition as soon as possible
Rationale: Early enteral nutrition (EN) is essential for ARDS patients to prevent mucosal damage and maintain nutritional status, as it helps to support healing and immune function. This approach is preferred over parenteral nutrition, as EN is associated with fewer complications.
A nurse is caring for a patient with ARDS who is at high risk for ventilator-associated pneumonia (VAP). Which of the following interventions is most likely to reduce the incidence of VAP?
A) Administering high-dose antibiotics regularly
B) Elevating the head of the bed to 30 to 45 degrees
C) Restricting all oral intake to prevent aspiration
D) Keeping the patient in the supine position for comfort
B) Elevating the head of the bed to 30 to 45 degrees
Rationale: Elevating the head of the bed to 30 to 45 degrees helps reduce the risk of aspiration, which is a primary risk factor for VAP. This positioning strategy is part of the VAP bundle, which also includes oral care, sedation minimization, and deep vein thrombosis prophylaxis.
A patient with ARDS is receiving mechanical ventilation with low tidal volume (VT) ventilation. The nurse knows that this strategy is used primarily to:
A) Prevent barotrauma by minimizing excessive lung pressure
B) Increase the volume of oxygen delivered to the lungs
C) Reduce the risk of ventilator-associated pneumonia
D) Increase patient comfort during the ventilatory cycle
A) Prevent barotrauma by minimizing excessive lung pressure
Rationale: Low tidal volume (VT) ventilation is used in ARDS patients to prevent barotrauma, which can occur when high pressure is applied to fragile alveoli. By using a smaller tidal volume, the risk of overdistension and lung injury is reduced.
A patient with ARDS is receiving mechanical ventilation and is being treated with permissive hypercapnia. The nurse understands that this approach involves:
A) Allowing for higher than normal levels of carbon dioxide (CO2) in the blood
B) Administering higher levels of oxygen to offset CO2 retention
C) Restricting fluid intake to reduce metabolic acidosis
D) Decreasing the rate of ventilation to minimize oxygen consumption
A) Allowing for higher than normal levels of carbon dioxide (CO2) in the blood
Rationale: Permissive hypercapnia is a strategy used in ARDS management that allows higher levels of CO2 in the blood in order to reduce ventilatory pressures and minimize the risk of barotrauma. The goal is to prevent overventilation and promote lung protection.
A nurse is assessing a patient with ARDS who is receiving inotropic therapy with dopamine. The nurse monitors for which of the following potential complications of dopamine therapy?
A) Hypotension
B) Bradycardia
C) Tachycardia
D) Hypokalemia
C) Tachycardia
Rationale: Dopamine is an inotropic medication that helps increase cardiac output and blood pressure. A known side effect of dopamine is tachycardia. The nurse should monitor the patient’s heart rate and rhythm closely to prevent adverse effects such as arrhythmias.
A nurse is caring for a patient who has just been diagnosed with ARDS. The patient’s condition is deteriorating rapidly, and the nurse must prioritize actions. Which of the following interventions should the nurse implement first?
A) Insert an arterial and/or central line
B) Administer vasopressors to maintain BP
C) Initiate mechanical ventilation and protect the airway
D) Obtain detailed patient information for assessment
C) Initiate mechanical ventilation and protect the airway
Rationale: The immediate priority in ARDS is to protect the airway and initiate mechanical ventilation to ensure proper oxygenation. While inserting lines and administering vasopressors are necessary later, securing the airway and providing respiratory support are the most critical interventions.
A nurse is assessing a patient with ARDS. Which of the following is the most common objective data finding that would suggest the patient is experiencing respiratory failure?
A) Decreased urine output
B) Cyanosis and altered mental status
C) Increased heart rate
D) Hypotension and tachypnea
B) Cyanosis and altered mental status
Rationale: Cyanosis (bluish discoloration of the skin due to lack of oxygen) and altered mental status are common signs of respiratory failure in ARDS patients. These findings are due to inadequate oxygenation and may indicate worsening respiratory distress or failure.
A nurse is conducting a rapid assessment on a patient suspected of having ARDS. The nurse knows that while obtaining the subjective and objective data, it may be difficult to gather complete patient information. Which of the following is the primary reason for this challenge in ARDS patients?
A) Patients with ARDS are often in shock, complicating data collection
B) Immediate mechanical ventilation and interventions are needed
C) ARDS patients typically have anxiety and cannot provide reliable information
D) There is insufficient equipment available to monitor patients with ARDS
B) Immediate mechanical ventilation and interventions are needed
Rationale: In ARDS, immediate interventions such as intubation, mechanical ventilation, and the initiation of vasopressors are required to stabilize the patient. This urgent care need often prevents the nurse from obtaining complete subjective and objective data during the initial assessment.
A nurse is preparing to assess a patient diagnosed with ARDS. What should be the nurse’s first priority in this assessment?
A) Assess the patient’s lung sounds
B) Obtain vital signs and assess respiratory status
C) Ask the patient about their medical history
D) Perform a full head-to-toe physical assessment
B) Obtain vital signs and assess respiratory status
Rationale: The nurse’s priority in ARDS assessment is to obtain vital signs and assess the patient’s respiratory status, as this directly impacts the patient’s oxygenation and overall condition. Although a full assessment is important, addressing airway, breathing, and circulation is the immediate priority in a critically ill patient.
A patient with ARDS is being managed in the ICU. The healthcare team is working to achieve an overall goal of PaO2 greater than 60 mm Hg. Which of the following interventions is most important for meeting this goal?
A) Administering IV fluids aggressively to maintain volume
B) Providing mechanical ventilation with high tidal volumes
C) Administering supplemental oxygen and adjusting settings on the ventilator
D) Performing chest physiotherapy to promote airway clearance
C) Administering supplemental oxygen and adjusting settings on the ventilator
Rationale: Administering supplemental oxygen and adjusting ventilator settings is crucial to increasing PaO2 levels and achieving adequate lung ventilation, which is a key goal in ARDS management.
A nurse is planning care for a patient with ARDS. The nurse understands that long-term goals for this patient include a PaO2 within normal limits for age. Which of the following interventions is most likely to improve PaO2?
A) Administering high doses of corticosteroids
B) Monitoring and adjusting the ventilator settings as needed
C) Discontinuing mechanical ventilation as soon as possible
D) Encouraging deep breathing exercises while awake
B) Monitoring and adjusting the ventilator settings as needed
Rationale: Monitoring and adjusting the ventilator settings, such as optimizing PEEP and tidal volumes, is essential to improving PaO2 levels and meeting the long-term goal for ARDS patients.
A patient with ARDS is being monitored for their oxygenation status. The goal is to achieve an SaO2 greater than 90%. Which of the following actions should the nurse prioritize to help achieve this goal?
A) Administering antibiotics as ordered to treat the underlying infection
B) Turning the patient every 2 hours to improve ventilation and perfusion
C) Maintaining adequate fluid balance through aggressive hydration
D) Using high-flow nasal cannula oxygen therapy
B) Turning the patient every 2 hours to improve ventilation and perfusion
Rationale: Regular repositioning helps improve ventilation and perfusion, which is essential for increasing SaO2 levels in ARDS patients.
A patient with ARDS has a long-term goal of achieving clear lungs on auscultation. Which intervention would best support this goal?
A) Monitoring for signs of respiratory muscle fatigue
B) Administering neuromuscular blocking agents
C) Implementing a mechanical ventilator strategy that limits tidal volume
D) Providing supplemental oxygen to maintain adequate PaO2
C) Implementing a mechanical ventilator strategy that limits tidal volume
Rationale: Limiting tidal volume helps prevent barotrauma and supports lung protection, which can help in achieving the goal of clear lungs on auscultation.
A patient with moderate ARDS is receiving mechanical ventilation in the ICU. The healthcare provider prescribes low tidal volume (VT) ventilation to minimize lung injury. Which of the following is the most likely rationale for this approach?
A) To improve the patient’s oxygenation by increasing lung compliance
B) To prevent overdistention of the alveoli and reduce the risk of barotrauma
C) To promote the recruitment of collapsed alveoli through higher pressures
D) To increase the patient’s work of breathing by reducing lung volumes
B) To prevent overdistention of the alveoli and reduce the risk of barotrauma
Rationale: Low tidal volume ventilation helps prevent overdistention of the alveoli and reduces the risk of barotrauma, which is important in ARDS patients to minimize further lung injury.
A nurse is managing a patient with ARDS in the ICU. The healthcare provider has ordered permissive hypercapnia as part of the ventilator management. Which of the following is the primary goal of this strategy?
A) To achieve a normal PaCO2 level while improving ventilation
B) To reduce the need for sedatives and neuromuscular blocking agents
C) To increase the effectiveness of positive end-expiratory pressure (PEEP)
D) To allow the body to tolerate higher levels of carbon dioxide without causing harm
D) To allow the body to tolerate higher levels of carbon dioxide without causing harm
Rationale: Permissive hypercapnia allows the body to tolerate higher levels of CO2, which helps minimize ventilator-associated lung injury by avoiding excessively high tidal volumes or peak pressures.
A patient with ARDS is receiving mechanical ventilation with PEEP in the ICU. Which of the following is a primary benefit of PEEP in this patient?
A) It helps to maintain alveolar patency and improve oxygenation
B) It increases the work of breathing to encourage muscle strength
C) It reduces the need for sedation by improving respiratory drive
D) It decreases the need for external oxygen supplementation
A) It helps to maintain alveolar patency and improve oxygenation
Rationale: PEEP helps maintain alveolar patency, preventing alveolar collapse, and improves oxygenation by promoting the recruitment of lung tissue.
A patient with severe ARDS is being managed in the ICU with ECMO. The nurse knows that ECMO is most beneficial in which of the following situations?
A) When the patient’s lung injury has been present for more than 7 days
B) When the patient has a high risk of developing pneumonia due to ventilation
C) When the patient’s blood pressure cannot be maintained without vasopressors
D) When the patient’s oxygenation cannot be adequately supported by conventional mechanical ventilation
D) When the patient’s oxygenation cannot be adequately supported by conventional mechanical ventilation
Rationale: ECMO is used to support oxygenation when conventional mechanical ventilation is unable to adequately oxygenate the patient, allowing time for lung recovery.
A nurse is providing care to a patient with ARDS who is being mechanically ventilated in the ICU. The nurse is performing ongoing assessments and monitoring. Which of the following should the nurse prioritize to monitor for complications related to mechanical ventilation?
A) Blood glucose levels and serum sodium levels
B) Serum calcium levels and ABGs
C) Urine output and daily weights
D) Continuous heart rate and respiratory rate
D) Continuous heart rate and respiratory rate
Rationale: Continuous monitoring of heart rate and respiratory rate is essential to assess the patient’s response to mechanical ventilation and detect potential complications such as respiratory distress or ventilator-associated events.
A patient with ARDS is receiving high-flow oxygen therapy, and the healthcare provider is closely monitoring the patient’s SpO2. What is the primary goal of oxygen therapy in this patient?
A) To correct hypercapnia by improving CO2 elimination
B) To correct hypoxemia and improve oxygen delivery to tissues
C) To prevent the need for mechanical ventilation by improving lung compliance
D) To increase lung volumes and improve tidal volume delivery
B) To correct hypoxemia and improve oxygen delivery to tissues
Rationale: The primary goal of oxygen therapy is to correct hypoxemia, improving oxygen delivery to the tissues and organs, which is crucial in ARDS management.
A nurse is caring for a patient with ARDS who is being managed with mechanical ventilation. The patient has been receiving a high FIO2 of 70% to maintain a PaO2 of at least 60 mm Hg. The nurse recognizes that during the injury and reparative phases, a PaO2 range of 55 to 80 mm Hg and SpO2 of 88% to 95% may be acceptable. What is the rationale for this approach?
A) A higher PaO2 and SpO2 will lead to better oxygen delivery to the tissues
B) Higher oxygen concentrations cause less damage to the lungs during the reparative phase
C) A lower PaO2 and SpO2 are accepted to minimize ventilator-induced lung injury
D) SpO2 levels above 95% reduce the risk of mechanical ventilation complications
C) A lower PaO2 and SpO2 are accepted to minimize ventilator-induced lung injury
Rationale: A lower-than-normal PaO2 and SpO2 are often accepted in ARDS patients to minimize ventilator-induced lung injury and reduce the risk of oxygen toxicity, especially during the injury and reparative phases.
A nurse is caring for a patient with ARDS who requires mechanical ventilation to maintain a PaO2 of at least 60 mm Hg. Which of the following is the best intervention for the nurse to implement when the patient’s oxygen saturation is below 88%?
A) Increase the tidal volume (VT) to improve oxygenation
B) Administer a higher FIO2 and closely monitor SpO2
C) Discontinue mechanical ventilation and place the patient on BiPAP
D) Provide oral suctioning to improve ventilation and oxygenation
B) Administer a higher FIO2 and closely monitor SpO2
Rationale: Administering a higher FIO2 and closely monitoring SpO2 are appropriate interventions for patients with ARDS to maintain an acceptable PaO2 level.
A patient with ARDS is receiving mechanical ventilation with an FIO2 of 70% to maintain PaO2. The nurse is monitoring SpO2 levels, which are at 90%. Which of the following would the nurse anticipate as part of ongoing therapy for this patient?
A) A reduction in FIO2 to avoid oxygen toxicity
B) Transition to BiPAP therapy to improve oxygenation
C) Use of higher levels of PEEP to maintain alveolar recruitment
D) Administering corticosteroids to improve oxygenation
C) Use of higher levels of PEEP to maintain alveolar recruitment
Rationale: Increasing PEEP helps to maintain alveolar recruitment and improve oxygenation, especially in ARDS patients who require higher levels of FIO2 to maintain adequate PaO2.
A nurse is caring for a patient with ARDS who is receiving high-flow oxygen via BiPAP. The nurse is aware that this form of therapy is only effective for a limited time. What is the most likely reason for this limitation?
A) BiPAP does not provide enough oxygen to maintain adequate PaO2 levels in severe ARDS
B) BiPAP can lead to increased tidal volume, contributing to barotrauma
C) High-flow oxygen therapy is not effective for patients with chronic lung disease
D) BiPAP increases the risk of ventilator-associated pneumonia
A) BiPAP does not provide enough oxygen to maintain adequate PaO2 levels in severe ARDS
Rationale: BiPAP is effective for a limited time in ARDS because, as respiratory failure worsens, high-flow oxygen cannot maintain acceptable PaO2 levels, necessitating mechanical ventilation for more effective oxygenation.
A nurse is caring for a patient with moderate ARDS who has been receiving high-flow oxygen therapy. The patient’s PaO2 is now at 58 mm Hg despite high-flow oxygen administration. Which of the following actions should the nurse prioritize next?
A) Continue the current oxygen therapy and monitor SpO2 closely
B) Increase the oxygen flow rate to 100% and reassess PaO2
C) Discontinue high-flow oxygen therapy and initiate BiPAP
D) Prepare for intubation and mechanical ventilation to maintain PaO2
D) Prepare for intubation and mechanical ventilation to maintain PaO2
Rationale: When high-flow oxygen therapy no longer maintains PaO2 levels within acceptable ranges, mechanical ventilation should be initiated to provide more effective oxygenation and support for the patient.
A patient with ARDS is being closely monitored for oxygen therapy effectiveness. The nurse is aware that a PaO2 of 55 to 80 mm Hg and an SpO2 of 88% to 95% may be acceptable during the reparative phase. What is the most important reason for maintaining these levels?
A) To prevent complications related to excessive oxygenation
B) To avoid ventilator-induced lung injury and oxygen toxicity
C) To decrease the workload on the ventilator settings
D) To optimize the patient’s respiratory rate and tidal volume
B) To avoid ventilator-induced lung injury and oxygen toxicity
Rationale: Maintaining PaO2 and SpO2 within these lower ranges helps reduce the risk of ventilator-induced lung injury and oxygen toxicity during the reparative phase of ARDS.
A nurse is caring for a patient with ARDS who has been receiving mechanical ventilation for 48 hours. The healthcare provider orders permissive hypercapnia. Which of the following is the rationale for implementing permissive hypercapnia in this patient?
A) To reduce ventilator-associated lung injury by avoiding high peak airway pressures
B) To promote more effective oxygenation while maintaining normal CO2 levels
C) To improve lung compliance by reducing the amount of oxygen delivered to the patient
D) To allow the kidneys to excrete excess carbon dioxide and balance pH
A) To reduce ventilator-associated lung injury by avoiding high peak airway pressures
Rationale: Permissive hypercapnia is used to reduce ventilator-associated lung injury by avoiding high peak airway pressures, which can cause further lung damage in ARDS patients.
A patient with moderate to severe ARDS requires mechanical ventilation. The healthcare provider decides to use pressure-control ventilation. What is the primary benefit of this mode of ventilation in ARDS management?
A) It increases the tidal volume delivered to the patient
B) It maintains low inspiratory and plateau pressures to prevent alveolar overdistention
C) It delivers higher oxygen concentrations to the patient
D) It promotes lung compliance and reduces the need for sedation
B) It maintains low inspiratory and plateau pressures to prevent alveolar overdistention
Rationale: Pressure-control ventilation helps prevent alveolar overdistention by maintaining low inspiratory and plateau pressures, which reduces the risk of lung injury in ARDS patients.
A patient with ARDS is receiving mechanical ventilation. The nurse knows that one of the goals of using pressure-control ventilation in this patient is to prevent which of the following complications?
A) Increased oxygen demand
B) Alveolar overdistention and rupture
C) Barotrauma due to high tidal volumes
D) Hypoventilation and respiratory acidosis
B) Alveolar overdistention and rupture
Rationale: The primary goal of pressure-control ventilation in ARDS is to prevent alveolar overdistention and rupture, which can lead to further lung injury.
A nurse is caring for a patient with moderate ARDS who is being mechanically ventilated using pressure-control ventilation. The nurse notices that the plateau pressure is rising above acceptable limits. Which action should the nurse take to prevent further lung injury?
A) Increase the tidal volume to improve oxygenation
B) Reduce the amount of positive end-expiratory pressure (PEEP)
C) Adjust the pressure settings to prevent further overdistention
D) Increase the oxygen concentration delivered to the patient
C) Adjust the pressure settings to prevent further overdistention
Rationale: Adjusting the pressure settings to prevent further overdistention is crucial when the plateau pressure is rising, as high pressures can lead to lung injury in ARDS patients.
A patient with ARDS is being managed with mechanical ventilation. The nurse understands that no mode of mechanical ventilation is superior to others. Which of the following is the most important consideration when choosing the ventilation mode for this patient?
A) The patient’s body weight and overall oxygen demand
B) The specific lung condition and severity of ARDS
C) The availability of ventilator equipment in the ICU
D) The patient’s preference for ventilation mode
B) The specific lung condition and severity of ARDS
Rationale: The choice of ventilation mode for ARDS patients depends on the severity of the condition and the specific lung issues, with modes adjusted to minimize injury and maximize oxygenation.
A patient with ARDS is being ventilated with a low tidal volume (VT) of 4 to 8 mL/kg. What is the primary reason for using a low VT in these patients?
A) To increase the volume of oxygen delivered to the lungs
B) To prevent barotrauma and volutrauma associated with stiff lungs
C) To improve the patient’s respiratory rate and oxygen saturation
D) To decrease the patient’s need for sedatives and neuromuscular blockers
B) To prevent barotrauma and volutrauma associated with stiff lungs
Rationale: The primary reason for using a low tidal volume (4 to 8 mL/kg) in ARDS patients is to prevent barotrauma and volutrauma, which can occur from delivering large volumes of air into stiff, noncompliant lungs.
A nurse is caring for a patient with ARDS who is on mechanical ventilation with a low tidal volume (VT) of 4 mL/kg. The healthcare provider explains that this approach reduces the risk of volutrauma. Which of the following is a consequence of volutrauma that this intervention helps to prevent?
A) Alveolar fractures and damage to the alveolar-capillary membrane
B) Decreased oxygenation due to inadequate ventilatory support
C) Increased fluid accumulation in the pleural cavity
D) Impaired gas exchange in the bronchial tree
A) Alveolar fractures and damage to the alveolar-capillary membrane
Rationale: Volutrauma refers to alveolar fractures and damage to the alveolar-capillary membrane, which can lead to fluid and protein accumulation in the alveolar spaces. Using a low tidal volume helps prevent this type of injury.
A patient with ARDS is receiving mechanical ventilation with low tidal volume (VT) of 4 to 8 mL/kg. The nurse recognizes that this approach primarily reduces the risk of which of the following complications?
A) Hypercarbia and respiratory acidosis
B) Volutrauma and barotrauma
C) Pneumothorax and subcutaneous emphysema
D) Atelectasis and bronchospasm
B) Volutrauma and barotrauma
Rationale: Low tidal volume ventilation helps to reduce the risks of volutrauma and barotrauma, which are complications that can result from delivering excessive tidal volumes to stiff lungs in ARDS.
A patient with ARDS is being mechanically ventilated using low tidal volume (VT) ventilation. The nurse understands that this approach is associated with which of the following outcomes?
A) Increased mortality and prolonged mechanical ventilation
B) Improved oxygenation but no impact on mortality
C) Decreased mortality and reduced risk for volutrauma
D) Increased incidence of barotrauma and lung injury
C) Decreased mortality and reduced risk for volutrauma
Rationale: Low tidal volume ventilation has been shown to decrease mortality in ARDS patients by reducing the risk of volutrauma and improving lung protection during mechanical ventilation.
A nurse is caring for a patient with ARDS who is receiving mechanical ventilation with low tidal volume (VT), leading to permissive hypercapnia. What is the primary rationale for allowing the PaCO2 to rise above normal limits in this patient?
A) To prevent volutrauma and barotrauma
B) To minimize the risk of hyperoxia
C) To reduce the duration of mechanical ventilation
D) To allow the brain and systemic circulation to compensate for the rise in CO2
D) To allow the brain and systemic circulation to compensate for the rise in CO2
Rationale: Permissive hypercapnia occurs as a consequence of low tidal volume ventilation. The gradual rise in PaCO2 allows the brain and systemic circulation to compensate for this change, which helps protect the lungs from further injury.
A patient with ARDS is being mechanically ventilated, and permissive hypercapnia is allowed. The nurse notes that the patient’s PaCO2 is rising and has reached 55 mm Hg. What is the most appropriate action for the nurse to take?
A) Discontinue mechanical ventilation and provide manual ventilation
B) Administer a dose of sodium bicarbonate to correct acidosis
C) Continue monitoring, ensuring the pH remains within 7.30–7.45 and the patient is stable
D) Increase the tidal volume to reduce the PaCO2 levels
C) Continue monitoring, ensuring the pH remains within 7.30–7.45 and the patient is stable
Rationale: In permissive hypercapnia, a gradual rise in PaCO2 is acceptable, as long as the pH remains within the target range (7.30–7.45). The nurse should continue monitoring and ensure the patient is stable before making any changes.
Which of the following patients is most likely to be excluded from permissive hypercapnia during mechanical ventilation?
A) A 45-year-old male with ARDS
B) A 30-year-old pregnant female with ARDS
C) A 60-year-old male with asthma and ARDS
D) A 35-year-old female with ARDS following trauma
B) A 30-year-old pregnant female with ARDS
Rationale: Permissive hypercapnia is not used in pregnant patients, as the rising PaCO2 can be harmful to both the mother and fetus.
A patient with ARDS is being mechanically ventilated with permissive hypercapnia. The nurse is aware that which of the following laboratory values will most likely be affected by permissive hypercapnia?
A) PaCO2
B) PaO2
C) HCO3-
D) Sodium levels
A) PaCO2
Rationale: Permissive hypercapnia involves allowing the PaCO2 to rise above normal levels (up to 60 mm Hg). This will directly affect the PaCO2 values.
When caring for a patient with ARDS who is undergoing mechanical ventilation with permissive hypercapnia, the nurse knows that the pH should be maintained within which range to prevent complications?
A) 6.80–7.10
B) 7.30–7.45
C) 7.45–7.60
D) 7.00–7.30
B) 7.30–7.45
Rationale: The pH should be maintained between 7.30 and 7.45 to prevent acidosis and allow for appropriate compensation during permissive hypercapnia.
A nurse is caring for a patient with ARDS who is being treated with permissive hypercapnia. Which of the following interventions is most likely to be used to manage this patient’s condition effectively?
A) Continuous IV analgesia and sedation
B) High-dose corticosteroids to reduce inflammation
C) Increased tidal volume for optimal oxygenation
D) Hyperventilation to decrease PaCO2 levels
A) Continuous IV analgesia and sedation
Rationale: To manage permissive hypercapnia, continuous IV analgesia and sedation are often used to ensure the patient’s comfort and tolerance to the rising PaCO2.
A patient with ARDS has been on mechanical ventilation for several days, and permissive hypercapnia is being used. The nurse notes that the patient’s PaCO2 is 58 mm Hg, and the pH is 7.35. The nurse understands that:
A) The patient is at risk for severe metabolic alkalosis.
B) The patient’s ventilator settings need to be adjusted to reduce the PaCO2.
C) The rise in PaCO2 is acceptable, and the pH is within the normal range.
D) The patient should be weaned off the ventilator immediately due to respiratory acidosis.
C) The rise in PaCO2 is acceptable, and the pH is within the normal range.
Rationale: In permissive hypercapnia, a rise in PaCO2 is acceptable if the pH remains within the normal range (7.30–7.45), and the patient is tolerating the change.
A patient with ARDS is receiving mechanical ventilation, and the healthcare provider is increasing the PEEP in increments. What is the primary goal of increasing the PEEP level in this patient?
A) To increase functional residual capacity and recruit collapsed alveoli
B) To reduce the need for oxygen therapy and recruit collapsed alveoli
C) To prevent barotrauma and volutrauma and recruit collapsed alveoli
D) To increase heart rate and improve venous return and recruit collapsed alveoli
A) To increase functional residual capacity and recruit collapsed alveoli
Rationale: The primary goal of increasing PEEP is to increase functional residual capacity and recruit collapsed alveoli, which improves oxygenation by preventing the collapse of small airways.
A nurse is caring for a patient with ARDS who is receiving mechanical ventilation with PEEP. The nurse understands that increasing PEEP may result in which of the following complications?
A) Increased preload and cardiac output
B) Increased venous return to the heart
C) Decreased venous return and compromised cardiac output
D) Improved oxygenation without any adverse effects
C) Decreased venous return and compromised cardiac output
Rationale: Higher levels of PEEP can compromise venous return to the heart, reducing cardiac output and preload, which can lead to hypotension and decreased oxygen delivery.
A patient with ARDS is being mechanically ventilated, and the healthcare provider increases the PEEP to 15 cm H2O to improve oxygenation. What is the potential risk associated with this intervention?
A) Increased risk of barotrauma and volutrauma
B) Improved oxygenation with no adverse effects
C) Decreased preload and reduced cardiac output
D) Decreased risk of complications due to reduced airway pressures
A) Increased risk of barotrauma and volutrauma
Rationale: Increasing PEEP to higher levels, such as 15 cm H2O, can increase the risk of barotrauma and volutrauma, potentially causing damage to the alveoli and surrounding tissues.
Which of the following is the most appropriate intervention if a patient on mechanical ventilation with PEEP develops hypotension?
A) Increase the PEEP further to improve oxygenation
B) Administer fluids or vasopressors to improve venous return
C) Decrease the tidal volume to reduce pressure
D) Reduce the FiO2 to prevent oxygen toxicity
B) Administer fluids or vasopressors to improve venous return
Rationale: If hypotension occurs with high PEEP, the best intervention is to administer fluids or vasopressors to improve venous return and restore cardiac output, as high PEEP can reduce preload and compromise BP.
A nurse is caring for a patient receiving mechanical ventilation with PEEP. The nurse understands that increasing the PEEP level:
A) Decreases alveolar recruitment and improves ventilation
B) Reduces the functional residual capacity and promotes atelectasis
C) Reduces venous return but has no effect on cardiac output
D) Increases the risk of barotrauma and decreases cardiac output
D) Increases the risk of barotrauma and decreases cardiac output
Rationale: Increasing PEEP can improve alveolar recruitment but also increases the risk of barotrauma and reduces cardiac output due to decreased venous return.
A patient with ARDS is receiving mechanical ventilation with PEEP set to 10 cm H2O. The nurse observes a decrease in blood pressure. Which of the following actions should the nurse prioritize?
A) Decrease the PEEP to reduce the intrathoracic pressure
B) Increase the tidal volume to improve oxygenation
C) Administer an analgesic to improve patient comfort
D) Increase the FiO2 to correct hypoxemia
A) Decrease the PEEP to reduce the intrathoracic pressure
Rationale: Decreasing the PEEP can help reduce the intrathoracic pressure and improve venous return, which may help increase blood pressure by restoring cardiac output and preload.
A patient with ARDS is receiving mechanical ventilation with a PEEP level of 20 cm H2O. Which of the following is the primary concern when using this high PEEP setting?
A) Increased risk of alveolar collapse
B) Decreased preload and cardiac output
C) Increased need for sedation and analgesia
D) Increased risk of ventilator-associated pneumonia (VAP)
B) Decreased preload and cardiac output
Rationale: High levels of PEEP, such as 20 cm H2O, can significantly reduce preload and cardiac output by increasing intrathoracic pressures, leading to a decrease in venous return and potentially causing hypotension.
Which of the following is the primary purpose of applying PEEP in patients with ARDS who are mechanically ventilated?
A) To increase inspiratory pressure and improve oxygenation
B) To reduce airway resistance and improve oxygenation
C) To prevent alveolar collapse and improve oxygenation
D) To lower the FiO2 requirements and improve oxygenation
C) To prevent alveolar collapse and improve oxygenation
Rationale: The primary purpose of applying PEEP is to prevent alveolar collapse, improving oxygenation by increasing functional residual capacity and recruiting collapsed alveoli.
A patient with ARDS and refractory hypoxemia is not responding to other interventions. The healthcare provider is considering prone positioning to improve oxygenation. What is the primary goal of prone positioning in these patients?
A) To increase airway resistance
B) To reduce the need for mechanical ventilation
C) To increase the FiO2 requirements
D) To better match perfusion to ventilation and improve oxygenation
D) To better match perfusion to ventilation and improve oxygenation
Rationale: The primary goal of prone positioning in ARDS patients is to improve oxygenation by better matching perfusion to ventilation, allowing alveoli in the posterior lungs to re-expand.
A patient with ARDS has been placed in the prone position after failing to respond to other interventions. The nurse monitors for which of the following potential complications while the patient is prone?
A) Improvement in oxygenation without any adverse effects
B) Hemodynamic instability, including dysrhythmias and decreased blood pressure
C) Increased airway resistance without any improvement in oxygenation
D) Decreased need for suctioning and airway management
B) Hemodynamic instability, including dysrhythmias and decreased blood pressure
Rationale: While prone positioning can improve oxygenation, it may also cause hemodynamic instability, including dysrhythmias and a decrease in blood pressure due to fluid shifts.
Which of the following is the most important nursing intervention when a patient is placed in the prone position for ARDS management?
A) Increasing the FiO2 to compensate for potential oxygenation issues
B) Administering bronchodilators to prevent airway collapse
C) Securing and maintaining the airway throughout the procedure
D) Monitoring for signs of pneumothorax
C) Securing and maintaining the airway throughout the procedure
Rationale: Securing and maintaining the airway is the most important consideration when placing a patient in the prone position, as airway management is critical to prevent complications.
A patient with ARDS has been proned for 12 hours. The nurse notices a significant improvement in the PaO2. What action should the nurse take next?
A) Decrease the PEEP and FiO2 settings
B) Immediately discontinue the prone position
C) Continue monitoring the patient in the prone position for another 12 hours
D) Increase sedation to maintain the prone position
A) Decrease the PEEP and FiO2 settings
Rationale: If there is an improvement in PaO2, it may be appropriate to decrease PEEP and FiO2 settings. This can help maintain oxygenation while reducing the risk of oxygen toxicity and barotrauma.
What is the recommended duration for prone positioning in patients with ARDS?
A) No more than 4 hours per day
B) Up to 16 hours per day
C) 24 hours continuously
D) Only until PaO2 improves
B) Up to 16 hours per day
Rationale: Research suggests that patients with ARDS can remain in the prone position for up to 16 hours per day to maximize benefits in improving oxygenation.
A patient with ARDS is being considered for prone positioning. Which of the following is a potential complication during the procedure?
A) Decreased secretion mobilization
B) Increased risk of deep vein thrombosis
C) Increased need for airway suctioning as secretions are mobilized
D) Decreased oxygenation
C) Increased need for airway suctioning as secretions are mobilized
Rationale: While the patient is in the prone position, secretions are mobilized, which can lead to an increased need for airway suctioning to prevent airway obstruction and improve ventilation.
A patient with ARDS is being placed in the prone position for oxygenation improvement. The healthcare team includes an intensivist, respiratory therapist, and at least three nurses. Which of the following is essential for the nurse to check before the patient is turned prone?
A) Verify the patient’s sedation levels to prevent discomfort
B) Ensure the patient’s blood pressure is stable before turning
C) Confirm the patient is on a low-flow oxygen system
D) Check for the presence of a nasogastric tube
B) Ensure the patient’s blood pressure is stable before turning
Rationale: Before turning the patient prone, it is essential to ensure the patient’s blood pressure is stable to avoid hemodynamic instability during fluid shifts that can occur when prone.
Which of the following alternative therapies may be used for patients with ARDS who are unable to tolerate prone positioning?
A) Continuous lateral rotation therapy (CLRT)
B) High-flow oxygen therapy
C) Deep sedation and paralysis
D) Use of extracorporeal membrane oxygenation (ECMO)
A) Continuous lateral rotation therapy (CLRT)
Rationale: Continuous lateral rotation therapy (CLRT) is an alternative to prone positioning that rotates the patient side-to-side to simulate postural drainage and help mobilize secretions.
What is the most critical step in ensuring patient safety during prone positioning for ARDS management?
A) Applying a continuous positive airway pressure (CPAP) mask
B) Adjusting the ventilator settings to higher pressures
C) Administering intravenous fluids to prevent hypotension
D) Properly securing and maintaining the airway
D) Properly securing and maintaining the airway
Rationale: Securing and maintaining the airway is critical to ensure patient safety during prone positioning, as the patient may be at increased risk of airway compromise.
A patient with ARDS is experiencing refractory hypoxemia despite high levels of PEEP and FiO2. The healthcare provider decides to place the patient in the prone position. What is the nurse’s primary role during this intervention?
A) Monitor for improvement in oxygenation
B) Immediately increase the ventilator settings to support the patient
C) Reduce the sedation level to assess the patient’s response
D) Assist in turning and positioning the patient safely, ensuring airway management
D) Assist in turning and positioning the patient safely, ensuring airway management
Rationale: The nurse’s primary role is to assist with turning the patient safely into the prone position, ensuring the airway is managed and protected throughout the procedure.
A patient with ARDS is placed prone in the ICU. What is the most likely outcome if prone positioning is successful?
A) A reduction in the need for sedation
B) A decrease in the need for mechanical ventilation
C) A stabilization of blood pressure and heart rate
D) An improvement in PaO2 and oxygenation
D) An improvement in PaO2 and oxygenation
Rationale: If prone positioning is successful, there is likely to be an improvement in PaO2 and overall oxygenation due to better matching of ventilation and perfusion.
When is the optimal time to initiate prone positioning for patients with ARDS?
A) Only after the patient has been ventilated for 48 hours
B) Once the patient becomes stable with improved oxygenation
C) As early as possible in the course of ARDS
D) After the patient is fully sedated and paralytics have been administered
C) As early as possible in the course of ARDS
Rationale: Research suggests that initiating prone positioning as early as possible in the course of ARDS can lead to better outcomes by improving oxygenation early on.
A patient with ARDS is placed in the prone position for 16 hours per day. The nurse should prioritize monitoring for which of the following?
A) Improvement in PaO2 and SpO2 levels
B) Increased risk of aspiration and pneumonia
C) Changes in cardiac output and blood pressure
D) Increased need for mechanical ventilation
C) Changes in cardiac output and blood pressure
Rationale: When a patient is placed in the prone position, there can be changes in cardiac output and blood pressure due to fluid shifts, so it is essential to monitor these closely for any signs of hemodynamic instability.
Which of the following best describes the function of ECMO in the management of critically ill patients?
A) ECMO filters and removes waste products from the blood, similar to hemodialysis
B) ECMO delivers oxygen into the blood and removes CO2, then returns oxygenated blood to the patient
C) ECMO replaces mechanical ventilation by directly supplying oxygen to the lungs
D) ECMO increases the blood flow rate to improve heart function during cardiac arrest
B) ECMO delivers oxygen into the blood and removes CO2, then returns oxygenated blood to the patient
Rationale: ECMO functions by delivering oxygen to the blood and removing CO2, which is then returned to the patient. It serves as a temporary life support system for patients with severe respiratory or cardiac failure.
A nurse is caring for a patient who has been placed on ECMO in a specialized ICU. Which of the following interventions is most important for the nurse to perform when managing this patient?
A) Monitor the patient for signs of fluid overload due to blood flow changes
B) Adjust the ECMO settings to optimize oxygenation levels continuously
C) Perform daily arterial blood gas (ABG) measurements to monitor the patient’s acid-base balance
D) Ensure the patient is placed in a high-Fowler’s position to facilitate ventilation
A) Monitor the patient for signs of fluid overload due to blood flow changes
Rationale: Monitoring for signs of fluid overload is crucial because the increased blood flow and extracorporeal circulation can lead to hemodynamic changes that may contribute to fluid imbalance.
What is the primary difference between ECMO and ECCO2R?
A) ECMO is used exclusively for cardiac failure, while ECCO2R is used for respiratory failure
B) ECCO2R requires higher blood flow rates than ECMO
C) ECMO supports both oxygenation and carbon dioxide removal, while ECCO2R is used only to enhance oxygenation
D) ECCO2R is a less expensive procedure that does not require specialized equipment
C) ECMO supports both oxygenation and carbon dioxide removal, while ECCO2R is used only to enhance oxygenation
Rationale: ECMO supports both oxygenation and carbon dioxide removal, whereas ECCO2R is primarily used to enhance oxygenation and does not require as high blood flow rates as ECMO.
Which of the following is a necessary consideration when implementing ECMO in critically ill patients?
A) It requires high blood flow rates to ensure adequate oxygenation
B) It is contraindicated in patients with any degree of heart failure
C) It can be performed without specialized training for ICU nurses
D) It is a cost-effective procedure with minimal risks to the patient
A) It requires high blood flow rates to ensure adequate oxygenation
Rationale: ECMO requires high blood flow rates to be effective in oxygenating blood and removing carbon dioxide. It is a complex and expensive procedure that demands specialized training for healthcare personnel.
A patient has been placed on ECMO for severe ARDS. The nurse is aware that ECMO is a highly specialized procedure that requires careful management. Which of the following is an essential aspect of nursing care for a patient on ECMO?
A) Ensuring that the ECMO device is used to replace mechanical ventilation
B) Discontinuing all sedative medications to prevent complications
C) Increasing the blood flow rates as soon as the patient shows signs of improvement
D) Frequently assessing the cannulation sites for signs of infection or complications
D) Frequently assessing the cannulation sites for signs of infection or complications
Rationale: Frequent assessment of the cannulation sites for infection, bleeding, or other complications is essential for patient safety and effective ECMO management. ECMO requires specialized care, and the patient should be monitored closely for adverse effects.
Which of the following is the primary reason for administering analgesia and sedation to patients with an endotracheal (ET) tube?
A) To prevent ventilator dyssynchrony and reduce work of breathing
B) To reduce the need for mechanical ventilation
C) To facilitate rapid weaning from the ventilator
D) To prevent complications related to fluid retention
A) To prevent ventilator dyssynchrony and reduce work of breathing
Rationale: Analgesia and sedation help reduce discomfort from the ET tube, decrease the work of breathing, and prevent ventilator dyssynchrony, improving overall patient comfort and ventilation effectiveness.
A patient receiving mechanical ventilation continues to breathe asynchronously despite receiving adequate analgesia and sedation. The healthcare provider decides to administer a neuromuscular blocking agent (NMBA). What is the most important consideration when using NMBAs in this patient?
A) NMBAs should be given alone to avoid complications associated with sedation
B) The patient may appear to be asleep but still feel pain, so analgesia and sedation must be given simultaneously
C) NMBAs can be used independently of monitoring drug levels
D) NMBAs should be used for short durations only to prevent respiratory failure
B) The patient may appear to be asleep but still feel pain, so analgesia and sedation must be given simultaneously
Rationale: When using NMBAs, it is essential to simultaneously administer analgesia and sedation, as the patient can still experience pain despite being paralyzed by the NMBA. Monitoring and providing adequate sedation is critical.
When managing a patient on mechanical ventilation who requires a neuromuscular blocking agent (NMBA), which of the following is an important nursing consideration?
A) The NMBA should be used without concurrent sedation
B) The patient must be weaned from the NMBA immediately after ventilator synchrony is achieved
C) A peripheral nerve stimulator should be used to assess the depth of paralysis
D) Continuous cardiac monitoring is unnecessary when NMBA is administered
C) A peripheral nerve stimulator should be used to assess the depth of paralysis
Rationale: A peripheral nerve stimulator is used to assess the depth of paralysis in patients receiving NMBA. This helps ensure the patient is adequately sedated and that paralysis is at the correct level for synchronization with the ventilator.
Which of the following is most likely to occur if a patient receiving mechanical ventilation has inadequate sedation or analgesia?
A) Increased synchrony with the ventilator
B) Decreased ventilator work of breathing (WOB)
C) Ventilator dyssynchrony and patient discomfort
D) Improved oxygenation and ventilation
C) Ventilator dyssynchrony and patient discomfort
Rationale: Inadequate sedation or analgesia can lead to ventilator dyssynchrony, which increases patient discomfort and impedes effective ventilation, resulting in poor outcomes.
A nurse is caring for a mechanically ventilated patient who is receiving a neuromuscular blocking agent (NMBA). Which of the following actions should the nurse take to assess the effectiveness of the NMBA and avoid complications?
A) Monitor the patient for signs of respiratory distress
B) Adjust the ventilator settings to ensure the patient is breathing in synchrony
C) Assess the patient’s pain level using a subjective scale
D) Use a peripheral nerve stimulator to monitor the depth of paralysis
D) Use a peripheral nerve stimulator to monitor the depth of paralysis
Rationale: A peripheral nerve stimulator is an effective tool for monitoring the depth of paralysis in patients receiving NMBA, ensuring they are appropriately sedated and paralyzed without excessive sedation or pain.
A patient receiving mechanical ventilation is experiencing ventilator dyssynchrony despite appropriate analgesia and sedation. What is the most likely cause of this issue?
A) The ventilator settings are too high for the patient’s respiratory rate
B) The patient is oversedated, resulting in delayed response to the ventilator
C) The ventilator is delivering too much oxygen
D) The patient is not receiving enough neuromuscular blockade
D) The patient is not receiving enough neuromuscular blockade
Rationale: If ventilator dyssynchrony occurs despite appropriate sedation, it may indicate that the patient is not receiving enough neuromuscular blockade. This can prevent the patient from synchronizing their breathing with the ventilator, even if they are adequately sedated.
Which of the following is a primary goal of using neuromuscular blocking agents (NMBA) in patients on mechanical ventilation?
A) To promote synchrony between the patient and the ventilator
B) To increase the patient’s level of consciousness
C) To enhance oxygenation through increased tidal volume
D) To increase the patient’s blood pressure and cardiac output
A) To promote synchrony between the patient and the ventilator
Rationale: The primary goal of using NMBAs is to promote synchrony between the patient and the ventilator, ensuring that the patient’s breathing aligns with the ventilator settings and reducing ventilator dyssynchrony.
Which of the following is the primary cause of decreased cardiac output (CO) in patients receiving positive pressure ventilation (PPV) with PEEP?
A) Increased intrathoracic pressure leading to decreased venous return
B) Decreased preload due to excess fluid administration
C) Decreased afterload due to reduced vascular resistance
D) Decreased oxygen delivery to tissues
A) Increased intrathoracic pressure leading to decreased venous return
Rationale: The increase in intrathoracic pressure caused by PEEP reduces venous return, which in turn decreases cardiac output (CO).
A patient with ARDS is receiving mechanical ventilation with PEEP and develops a decrease in cardiac output. What is the most likely cause of this decrease in CO?
A) Excessive preload leading to ventricular overload
B) Hyperinflation of the alveoli causing increased right ventricular afterload
C) Decreased systemic vascular resistance
D) Increased left ventricular preload due to fluid overload
B) Hyperinflation of the alveoli causing increased right ventricular afterload
Rationale: Alveolar hyperinflation due to PEEP increases right ventricular afterload, impairing blood flow from the right side of the heart and leading to a decrease in CO.
Which of the following is an early indicator of decreased cardiac output in a patient receiving mechanical ventilation?
A) Increase in mean arterial pressure (MAP)
B) A decrease in pulse pressure
C) An increase in mixed venous oxygen saturation (SvO2)
D) A decrease in blood pressure and oxygen saturation
D) A decrease in blood pressure and oxygen saturation
Rationale: A decrease in blood pressure and oxygen saturation are early indicators of decreased CO, suggesting a lack of adequate tissue perfusion.
Which hemodynamic monitoring parameter is essential to assess tissue perfusion in a patient receiving mechanical ventilation for ARDS?
A) Pulse rate
B) Arterial blood gases (ABGs)
C) Central venous pressure (CVP)
D) Capillary refill time
C) Central venous pressure (CVP)
Rationale: Central venous pressure (CVP) is an essential parameter to monitor as it provides information about venous return, preload, and the overall hemodynamic status of the patient.
A patient with ARDS on mechanical ventilation develops a decrease in cardiac output (CO). The healthcare provider orders the initiation of IV fluids and vasoactive medications. What is the primary goal of this intervention?
A) To increase systemic vascular resistance
B) To improve oxygenation by increasing alveolar ventilation
C) To restore normal blood pressure and improve tissue perfusion
D) To reduce right ventricular afterload
C) To restore normal blood pressure and improve tissue perfusion
Rationale: The primary goal of IV fluids and vasoactive medications in this scenario is to restore normal blood pressure and improve tissue perfusion, addressing the decrease in CO.
Which of the following findings would most likely indicate adequate tissue perfusion in a patient receiving mechanical ventilation for ARDS?
A) Decreased mixed venous oxygen saturation (SvO2)
B) Increased blood pressure and stable heart rate
C) Decreased mean arterial pressure (MAP)
D) Elevated central venous pressure (CVP)
B) Increased blood pressure and stable heart rate
Rationale: Increased blood pressure and a stable heart rate indicate adequate tissue perfusion. These parameters suggest that the heart is effectively pumping blood and oxygen to the tissues.
Which of the following is a potential complication of positive pressure ventilation (PPV) in patients with ARDS that can lead to decreased cardiac output (CO)?
A) Decreased alveolar compliance leading to reduced venous return
B) Decreased lung compliance leading to reduced venous return
C) Increased intrathoracic pressure leading to reduced venous return
D) Increased pulmonary blood flow leading to reduced venous return
C) Increased intrathoracic pressure leading to reduced venous return
Rationale: Increased intrathoracic pressure caused by PPV can reduce venous return, leading to decreased CO due to impaired preload and decreased right ventricular filling.
A nurse is monitoring a patient’s hemodynamic status after the initiation of mechanical ventilation with PEEP. Which of the following findings would indicate a need for further intervention to optimize tissue perfusion?
A) Increase in arterial oxygen saturation (SaO2)
B) Increased mean arterial pressure (MAP)
C) Decrease in central venous pressure (CVP)
D) Decrease in pulse pressure
C) Decrease in central venous pressure (CVP)
Rationale: A decrease in CVP may indicate inadequate preload or venous return, requiring further intervention to optimize tissue perfusion.
A patient on mechanical ventilation with PEEP develops hemodynamic instability with decreased cardiac output (CO). Which of the following interventions would the nurse expect to be implemented to improve tissue perfusion?
A) Administration of high-dose steroids to reduce inflammation
B) Administration of diuretics to reduce preload
C) Increase in FIO2 to improve oxygenation
D) Adjustment of ventilator settings to decrease intrathoracic pressure
D) Adjustment of ventilator settings to decrease intrathoracic pressure
Rationale: Adjusting ventilator settings to decrease intrathoracic pressure can help improve venous return, which may improve CO and tissue perfusion in the patient with ARDS.
Which of the following is the most appropriate nursing action when managing fluid balance in a patient with ARDS?
A) Administer aggressive IV fluids to maintain adequate hydration
B) Monitor hemodynamic parameters, urine output, and daily weights
C) Increase fluid intake to promote kidney function
D) Restrict all fluid intake to prevent pulmonary edema
B) Monitor hemodynamic parameters, urine output, and daily weights
Rationale: Monitoring hemodynamic parameters, urine output, and daily weights is crucial for assessing fluid volume status in ARDS patients. It helps prevent both fluid overload and dehydration, managing the delicate balance of fluid.
A patient with ARDS is at risk for fluid retention and pulmonary edema. Which of the following interventions is most appropriate for maintaining fluid balance?
A) Start enteral nutrition immediately within 24 to 48 hours
B) Administer high doses of IV fluids to support blood pressure
C) Administer diuretics to remove excess fluid
D) Restrict all enteral feeding until fluid balance is stable
A) Start enteral nutrition immediately within 24 to 48 hours
Rationale: Enteral nutrition (EN) should be started as soon as possible within 24 to 48 hours to maintain protein and energy stores. This helps prevent muscle loss, including respiratory muscles, which can prolong mechanical ventilation.
Which of the following is an essential component in the management of nutrition for a patient with ARDS?
A) Avoid starting enteral nutrition until the patient is fully stabilized
B) Focus on aggressive fluid resuscitation to maintain vascular volume
C) Begin enteral nutrition as soon as possible to prevent muscle mass loss
D) Monitor only caloric intake, disregarding protein levels
C) Begin enteral nutrition as soon as possible to prevent muscle mass loss
Rationale: Starting enteral nutrition (EN) within 24 to 48 hours is essential to maintain protein and energy stores, preventing muscle loss, including respiratory muscles, and reducing the risk of prolonged mechanical ventilation.
What is the role of diuretics in managing fluid balance in ARDS patients?
A) They should be used aggressively to manage fluid retention and pulmonary edema.
B) Diuretics should be used as the primary method of fluid management.
C) They are rarely effective in ARDS because of the inflammatory nature of the condition.
D) Diuretics are not recommended under any circumstances for ARDS patients.
C) They are rarely effective in ARDS because of the inflammatory nature of the condition.
Rationale: Diuretics play a minimal role in managing fluid retention in ARDS due to the inflammatory nature of the condition. Fluid management is better achieved through careful monitoring of fluid intake, output, and hemodynamic parameters.
When caring for a patient with ARDS, which of the following is the most appropriate way to prevent excessive fluid retention?
A) Aggressive resuscitation with IV fluids to prevent hypotension
B) Strict monitoring of intake and output, along with daily weights
C) Administration of high doses of albumin to support vascular volume
D) Initiating dialysis immediately to remove excess fluids
B) Strict monitoring of intake and output, along with daily weights
Rationale: Strict monitoring of intake and output, along with daily weights, is essential to prevent excessive fluid retention and maintain fluid balance in ARDS patients. It helps identify early signs of fluid overload, such as pulmonary edema.
Which of the following actions should be avoided when managing fluid balance in a patient with ARDS?
A) Using CRRT (Continuous Renal Replacement Therapy) to remove small amounts of fluid hourly
B) Avoiding aggressive IV fluid resuscitation to prevent fluid overload
C) Monitoring urine output and hemodynamic parameters to assess fluid status
D) Administering diuretics to rapidly remove fluid from the body
D) Administering diuretics to rapidly remove fluid from the body
Rationale: Diuretics should be used minimally in ARDS patients because of the inflammatory nature of the condition. Aggressive fluid removal can worsen hemodynamic instability and should be avoided in favor of more cautious fluid management strategies.
Which of the following outcomes indicates successful management of a patient with ARDS?
A) The patient requires an increased amount of oxygen to maintain oxygenation.
B) The patient remains hemodynamically unstable despite treatment.
C) The patient maintains adequate oxygenation with decreasing amounts of oxygen.
D) The patient experiences complications related to mechanical ventilation.
C) The patient maintains adequate oxygenation with decreasing amounts of oxygen.
Rationale: Successful management of ARDS includes the patient maintaining adequate oxygenation and ventilation while requiring decreasing amounts of oxygen, indicating improvement in the condition and successful treatment.
Which of the following is an appropriate goal for the nursing care of a patient with ARDS?
A) The patient should remain free of complications, maintain hemodynamic stability, and reduce oxygen requirements.
B) The patient should have a prolonged dependence on mechanical ventilation to prevent complications.
C) The patient should be able to maintain oxygenation without the need for any sedation or analgesia.
D) The patient should demonstrate severe hypoxemia as an indicator of disease progression.
A) The patient should remain free of complications, maintain hemodynamic stability, and reduce oxygen requirements.
Rationale: The appropriate goal for nursing care in ARDS is for the patient to remain free of complications, maintain hemodynamic stability, and require decreasing amounts of oxygen, which demonstrates the effectiveness of treatment and improving condition.
The most common early manifestations of ARDS that the nurse may see are
a. dyspnea and tachypnea.
b. cyanosis and apprehension.
c. respiratory distress and frothy sputum.
d. bradycardia and increased work of breathing.
a. dyspnea and tachypnea.
Interventions used in managing the patient with ARDS include (select all that apply)
a. prone positioning.
b. IV injection of surfactant.
c. low tidal volume ventilation.
d. aggressive IV fluid resuscitation.
e. positive end expiratory pressure (PEEP).
a. prone positioning.
c. low tidal volume ventilation.
e. positive end expiratory pressure (PEEP).
Which intervention is most likely to prevent or limit volutrauma in the patient with ARDS who is mechanically ventilated?
a. Increasing PEEP
b. Increasing the inspiratory flow rate
c. Use of low tidal volume ventilation
d. Suctioning the patient via endotracheal tube hourly
c. Use of low tidal volume ventilation
A patient with acute respiratory distress syndrome (ARDS) and acute kidney injury has several drugs prescribed. Which drug would the nurse discuss with the health care provider before giving?
a. Vancomycin (Vancocin)
b. Pantoprazole (Protonix)
c. Sucralfate (Carafate)
d. Methylprednisolone (Solu-Medrol)
a. Vancomycin (Vancocin)
Rationale: Vancomycin is potentially nephrotoxic, and the nurse should clarify the drug and dosage with the health care provider before administration. The other drugs are appropriate for the patient with ARDS.
A patient develops increasing dyspnea and hypoxemia 2 days after heart surgery. Which procedure would the nurse anticipate assisting with to determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by heart failure?
a. Obtaining a ventilation-perfusion scan
b. Drawing blood for arterial blood gases
c. Positioning the patient for a chest x-ray
d. Inserting a pulmonary artery catheter
d. Inserting a pulmonary artery catheter
Rationale: 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.
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
b. The patient has subcutaneous emphysema on the upper thorax.
Rationale: The subcutaneous emphysema indicates barotrauma caused by positive pressure ventilation and PEEP. Bradycardia, hypoxemia, and bronchial breath sounds are all concerns that need to be addressed, but they are not specific indications that PEEP should be reduced.
Which statement by the nurse to the patient‘s caregiver about the purpose of positive end-expiratory pressure (PEEP) 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% O2 to the lungs.”
b. “PEEP prevents the lung air sacs from collapsing during exhalation.”
Rationale: 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 (FIO 2 ) delivered to the patient.
Prone positioning is being used for a patient with acute respiratory distress syndrome (ARDS). 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.
c. Sputum and blood cultures show no growth after 48 hours.
d. The skin on the patient‘s back is intact and without redness.
a. The patient‘s PaO2 is 89 mm Hg, and the SaO2 is 91%.
Rationale: The purpose of prone positioning is to improve the patient‘s oxygenation as indicated by the PaO2 and SaO2 . The other information will be collected but does not indicate whether prone positioning has been effective.
The nurse assesses vital signs for a patient admitted 2 days ago with gram-negative sepsis: temperature of 101.2F, blood pressure of 90/56 mm Hg, pulse of 92 beats/min, and respirations of 34 breaths/min. Which action would the nurse take next?
a. Give the scheduled IV antibiotic.
b. Give the PRN acetaminophen (Tylenol).
c. Obtain oxygen saturation using pulse oximetry.
d. Notify the health care provider of these findings.
c. Obtain oxygen saturation using pulse oximetry.
Rationale: The patient‘s increased respiratory rate in combination with the admission diagnosis of gram-negative sepsis indicates that acute respiratory distress syndrome (ARDS) may be developing. The nurse should check for hypoxemia, a hallmark of ARDS. The health care provider should be notified after further assessment of the patient. Giving the scheduled antibiotic and the PRN acetaminophen will also be done, but they are not the highest priority for a patient who may be developing ARDS.
A patient with acute respiratory distress syndrome (ARDS) who is intubated and receiving mechanical ventilation develops a right pneumothorax. Which collaborative action will the nurse anticipate next?
a. Increase the tidal volume and respiratory rate.
b. Decrease the fraction of inspired oxygen (FIO2 ).
c. Perform endotracheal suctioning more frequently.
d. Lower the positive end-expiratory pressure (PEEP).
d. Lower the positive end-expiratory pressure (PEEP).
Rationale: Because barotrauma is associated with high airway pressures, the level of PEEP should be decreased. The other actions will not decrease the risk for another pneumothorax.
After receiving change-of-shift report on a medical unit, which patient would the nurse assess first?
a. A patient with cystic fibrosis who has thick, green-colored sputum
b. A patient with pneumonia who has crackles bilaterally in the lung bases
c. A patient with emphysema who has an oxygen saturation of 90% to 92%
d. A patient with septicemia who has intercostal and suprasternal retractions
d. A patient with septicemia who has intercostal and suprasternal retractions
Rationale: This patient‘s history of septicemia and labored breathing suggest the onset of ARDS, which will require rapid interventions such as administration of O2 and use of positive-pressure ventilation. The other patients should also be assessed, but their assessment data are typical of their disease processes and do not suggest deterioration in their status.
The nurse is caring for an older patient who was hospitalized 2 days earlier with community-acquired pneumonia. Which assessment information is most important to communicate to the health care provider?
a. Persistent cough of blood-tinged sputum
b. Scattered crackles in the posterior lung bases
c. Oxygen saturation 90% on 100% O2 by non-rebreather mask
d. Temperature 101.5F (38.6C) after 2 days of IV antibiotics
c. Oxygen saturation 90% on 100% O2 by non-rebreather mask
Rationale: The patient‘s low SpO2 despite receiving a high fraction of inspired oxygen (FIO2 ) indicates the possibility of acute respiratory distress syndrome (ARDS). The patient‘s blood-tinged sputum and scattered crackles are not unusual in a patient with pneumonia, although they do need continued monitoring. The continued temperature elevation indicates a possible need to change antibiotics, but this is not as urgent a concern as the progression toward hypoxemia despite a high O2 flow flowrate.
A nurse is caring for a patient with acute respiratory distress syndrome (ARDS) who is receiving mechanical ventilation using synchronized intermittent mandatory ventilation (SIMV). The settings include fraction of inspired oxygen (FIO2 ) of 80%, tidal volume of 450, rate of 16/minute, and positive end-expiratory pressure (PEEP) of 5 cm. Which assessment finding is most important for the nurse to report to the health care provider?
a. O2 saturation of 99%
b. Heart rate 106 beats/min
c. Crackles audible at lung bases
d. Respiratory rate 22 breaths/min
a. O2 saturation of 99%
Rationale: The FIO2 of 80% increases the risk for O2 toxicity. Because the patient‘s O2 saturation is 99%, a decrease in FIO2 could help to avoid toxicity. The other patient data would be typical for a patient with ARDS and would not be the most important data to report to the health care provider.
The nurse is caring for a patient who is intubated and receiving positive pressure ventilation to treat acute respiratory distress syndrome (ARDS). Which finding is most important to report to the health care provider?
a. Red-brown drainage from nasogastric tube
b. Blood urea nitrogen (BUN) level 32 mg/dL
c. Scattered coarse crackles heard throughout lungs
d. Arterial blood gases: pH of 7.31, PaCO2 of 50, and PaO2 of 68
a. Red-brown drainage from nasogastric tube
Rationale: The nasogastric drainage indicates possible gastrointestinal bleeding or stress ulcer and should be reported. The pH and PaCO2 are slightly abnormal, but current guidelines advocating for permissive hypercapnia indicate that these would not indicate an immediate need for a change in therapy. The BUN is slightly elevated but does not indicate an immediate need for action. Adventitious breath sounds are often heard in patients with ARDS.
