QUIZ 3 (AKI, ARF, ARD) Flashcards
AKI, ARF, ARD
1
Q
AKI Which of the following laboratory findings is most indicative of acute kidney injury (AKI)?
A. Decreased BUN
B. Decreased creatinine
C. Decreased potassium
D. Increased BUN and creatinine
A
Answer: D
Rationale: AKI is characterized by increased BUN and creatinine due to reduced filtration.
2
Q
Which is the most common cause of intrarenal AKI in hospitalized patients?
A. Nephrotic syndrome
B. Acute tubular necrosis (ATN)
C. Bladder cancer
D. Anaphylaxis
A
Answer: B
Rationale: ATN is the most frequent intrarenal cause due to ischemia or nephrotoxins.
3
Q
What is the best indicator of kidney function in AKI?
A. BUN
B. Urine output
C. Serum creatinine
D. Hematocrit
A
Answer: C
Rationale: Creatinine is a more reliable marker as it’s less affected by other conditions.
4
Q
Which ECG change is associated with hyperkalemia?
A. U waves
B. Peaked T waves
C. ST elevation
D. Shortened PR interval
A
Answer: B
Rationale: Hyperkalemia causes peaked T waves and can lead to dysrhythmias.
5
Q
A patient with postrenal AKI most likely has which condition?
A. Heart failure
B. Dehydration
C. Nephrotoxic drugs
D. Benign prostatic hyperplasia (BPH)
A
Answer: D
Rationale: BPH causes urinary obstruction, a hallmark of postrenal AKI.
6
Q
What is the earliest phase of AKI progression according to RIFLE criteria?
A. Failure
B. Loss
C. Risk
D. End-stage
A
Answer: C
Rationale: “Risk” is the first stage in the RIFLE classification.
7
Q
What finding best suggests metabolic acidosis in AKI?
A. Elevated pH
B. High bicarbonate
C. Decreased bicarbonate
D. Hypoventilation
A
Answer: C
Rationale: Bicarbonate is lost due to reduced kidney reabsorption.
8
Q
Which of the following is a prerenal cause of AKI?
A. Glomerulonephritis
B. BPH
C. Hypovolemia
D. Nephrotoxins
A
Answer: C
Rationale: Prerenal AKI results from reduced blood flow, often from hypovolemia.
9
Q
Which is an expected finding during the diuretic phase of AKI?
A. Hyperkalemia
B. Oliguria
C. Fluid retention
D. Dehydration
A
Answer: D
Rationale: Excessive diuresis can lead to volume depletion and electrolyte imbalances.
10
Q
Which therapy removes potassium most effectively and rapidly?
A. Kayexalate
B. Patiromer
C. Hemodialysis
D. Sodium bicarbonate
A
Answer: C
Rationale: Hemodialysis is the most effective method for removing potassium.
11
Q
What is the most common cause of death in patients with AKI?
A. Infection
B. Hyperkalemia
C. Sepsis
D. Hemorrhage
A
Answer: A
Rationale: Infection, especially of the respiratory or urinary tract, is the leading cause.
12
Q
What is a hallmark of the oliguric phase of AKI?
A. Polyuria
B. Urine output >500 mL/day
C. Urine output <400 mL/day
D. Proteinuria
A
Answer: C
Rationale: Oliguria is defined as urine output <400 mL/day.
13
Q
A patient with AKI has a serum potassium level of 6.5 mEq/L. What is the priority action?
A. Administer sodium bicarbonate
B. Encourage fluid intake
C. Prepare for dialysis
D. Monitor intake and output
A
Answer: C
Rationale: Dialysis is the fastest way to correct dangerously high potassium.
14
Q
Which medication should not be given to a patient with paralytic ileus?
A. Furosemide
B. Kayexalate
C. Calcium gluconate
D. Sodium bicarbonate
A
Answer: B
Rationale: Kayexalate can cause bowel necrosis in patients with paralytic ileus.
15
Q
Which diagnostic test is safest to use first for AKI?
A. CT with contrast
B. MRI
C. Kidney ultrasound
D. Renal biopsy
A
Answer: C
Rationale: Ultrasound is noninvasive and doesn’t involve nephrotoxic contrast.
16
Q
Which of the following is a prerenal cause of acute kidney injury (AKI)?
A. Acute glomerulonephritis
B. Anaphylaxis
C. BPH
D. Contrast media
A
Answer: B
Rationale: Anaphylaxis causes vasodilation and decreased peripheral vascular resistance, reducing renal perfusion—making it a prerenal cause.
17
Q
A patient has a history of taking aminoglycoside antibiotics for a serious infection. Which type of AKI is this patient at risk for?
A. Prerenal
B. Intrarenal
C. Postrenal
D. Functional
A
Answer: B
Rationale: Aminoglycosides (e.g., gentamicin) are nephrotoxic drugs that directly damage the renal tubules, leading to intrarenal AKI.
18
Q
Which of the following is most likely to cause postrenal AKI?
A. Renal artery thrombosis
B. Heart failure
C. Prostate cancer
D. Dehydration
A
Answer: C
Rationale: Postrenal AKI is due to obstruction of urinary outflow. Prostate cancer is a common mechanical obstruction cause.
19
Q
A nurse is reviewing the chart of a patient with severe burns and low urine output. Which type of AKI is most likely?
A. Prerenal
B. Postrenal
C. Intrarenal
D. None; burns don’t affect the kidneys
A
Answer: A
Rationale: Burns lead to hypovolemia, reducing renal perfusion and causing prerenal AKI.
20
Q
A patient with a recent diagnosis of systemic lupus erythematosus (SLE) develops AKI. This is an example of which type of kidney injury?
A. Postrenal
B. Prerenal
C. Intrarenal
D. Functional
A
Answer: C
Rationale: SLE can cause inflammation and damage to kidney tissues, classifying it as intrarenal AKI.
21
Q
Which nutrition therapy is recommended for a patient with AKI?
A. High-protein diet
B. Low-carbohydrate, high-fat diet
C. Moderate protein with increased fats and carbs
D. Protein-free diet
A
Answer: C
Rationale: AKI patients require adequate calories to prevent catabolism, with moderate protein intake and increased fats and carbs as energy sources.
22
Q
Which diagnostic test is typically first ordered for AKI evaluation?
A. CT scan with contrast
B. Kidney ultrasound
C. Renal biopsy
D. MRI
A
Answer: B
Rationale: A kidney ultrasound is noninvasive, safe, and avoids nephrotoxic contrast—making it the first imaging choice in AKI.
23
Q
A patient presents with elevated creatinine and decreased urine output. Which AKI stage per RIFLE applies?
A. Risk
B. Injury
C. Failure
D. Loss
A
Answer: A
Rationale: The “Risk” stage includes serum creatinine increase ×1.5 or GFR decrease by 25% and urine output <0.5 mL/kg/hr for 6 hours.
24
Q
Which ECG finding is most concerning in hyperkalemia?
A. Flat T wave
B. Sinus bradycardia
C. Shortened QRS
D. Peaked T wave
A
Answer: D
Rationale: Tall, peaked T waves are a hallmark of hyperkalemia and signal risk for serious cardiac dysrhythmias.
25
A patient with AKI has fluid overload. Which is the best nursing intervention?
A. Increase IV fluids
B. Monitor for crackles and edema
C. Limit activity
D. Encourage protein intake
Answer: B
Rationale: Monitoring for signs of fluid overload is critical in the oliguric phase to prevent complications like pulmonary edema.
26
Which action is a priority during the initial nursing assessment of a patient with AKI?
A. Review allergy history
B. Auscultate lung sounds
C. Check IV site
D. Assess bowel sounds
Answer: B
Rationale: Fluid overload may lead to pulmonary edema. Lung assessment is essential early in AKI evaluation.
27
A patient recovering from AKI asks when full kidney function will return. What is the best response?
A. "You’ll fully recover in 2 weeks."
B. "It depends on your dialysis schedule."
C. "Kidney function may take up to 12 months to stabilize."
D. "You may need lifelong dialysis."
Answer: C
Rationale: Recovery from AKI can take up to a year, depending on severity and patient factors. Many patients regain function gradually.
28
What is the most serious electrolyte imbalance in AKI?
A. Hyponatremia
B. Hyperkalemia
C. Hypocalcemia
D. Hyperphosphatemia
Answer: B
Rationale: Hyperkalemia is potentially fatal because it can cause life-threatening cardiac dysrhythmias.
29
Which finding is most consistent with prerenal AKI?
A. Proteinuria
B. Sodium excretion >40 mEq/L
C. Dehydration and low urine sodium
D. Hematuria
Answer: C
Rationale: Prerenal AKI presents with low urine sodium (<20 mEq/L) and signs of hypovolemia such as dehydration.
30
Which condition contributes most to the development of intrarenal AKI?
A. Contrast dye nephropathy
B. Severe hypotension
C. Heart failure
D. BPH
Answer: A
Rationale: Contrast-induced nephropathy directly damages the renal tubules, causing intrarenal AKI.
31
During the diuretic phase of AKI, the nurse should monitor for which complication?
A. Hypernatremia
B. Fluid retention
C. Hypokalemia
D. Pulmonary edema
Answer: C
Rationale: High urine output in the diuretic phase can cause potassium loss and hypokalemia.
32
What is the best indicator for determining fluid volume status in a patient with AKI?
A. Blood pressure
B. Intake and output
C. Daily weight
D. Skin turgor
Answer: C
Rationale: Daily weight is the most reliable, sensitive indicator of changes in fluid balance.
33
What does the presence of renal tubular casts in a urinalysis suggest?
A. Prerenal AKI
B. Postrenal obstruction
C. Intrarenal damage
D. Dehydration
Answer: C
Rationale: Casts form from dead tubular cells and are a hallmark of intrarenal AKI, especially ATN.
34
What treatment temporarily shifts potassium into cells during hyperkalemia?
A. Calcium gluconate
B. Kayexalate
C. Insulin with glucose
D. Diuretics
Answer: C
Rationale: Insulin shifts potassium into cells. Glucose prevents hypoglycemia during this process.
35
Which patient is most at risk for developing AKI?
A. A 25-year-old athlete with muscle cramps
B. A 68-year-old with sepsis and CKD
C. A 35-year-old with GERD
D. A 50-year-old with seasonal allergies
Answer: B
Rationale: Older patients with comorbidities like sepsis and CKD are high risk due to decreased renal reserve.
36
What are three prerenal causes?
MI, dehydration, and decrease cardiac output
37
What is one cause of intrarenal AKI?
Injury
38
What is three causes of postrenal AKI?
BPH, cancer, and blockage
39
Decrease your output over 24 hours, fatigue, nausea, vomiting for 24 hours, edema, shortness of breath upon exertion, and confusion within the last 12 hours would indicate what?
AKI
40
First things to do when a patient comes in with suspected AKI?
ECG, CMP, urinalysis, and ultrasound.
41
What PaO2 value indicates hypoxemic respiratory failure?
A. PaO2 < 80 mm Hg
B. PaO2 < 70 mm Hg
C. PaO2 < 60 mm Hg
D. PaO2 < 50 mm Hg
Answer: C
Rationale: Hypoxemic respiratory failure is defined as a PaO2 less than 60 mm Hg on room air.
42
Which of the following indicates hypercapnic respiratory failure?
A. PaCO2 < 35 mm Hg
B. PaCO2 > 50 mm Hg
C. PaCO2 between 35–45 mm Hg
D. SpO2 < 90%
Answer: B
Rationale: Hypercapnic respiratory failure is defined by a PaCO2 greater than 50 mm Hg, often accompanied by a pH < 7.35.
43
Which condition commonly causes a ventilation-perfusion (V/Q) mismatch?
A. Flail chest
B. Pneumonia
C. Tension pneumothorax
D. High-output heart failure
Answer: B
Rationale: Pneumonia leads to fluid-filled alveoli, preventing effective ventilation despite continued perfusion.
44
What is the first-line treatment for hypoxemia due to a V/Q mismatch?
A. Antibiotics
B. Diuretics
C. Oxygen therapy
D. Bronchodilators
Answer: C
Rationale: Oxygen therapy is the first-line intervention to correct hypoxemia from V/Q mismatch.
45
A patient with a shunt-related ARF is unlikely to respond to which treatment alone?
A. Bronchodilators
B. Diuretics
C. Oxygen therapy
D. Mechanical ventilation with high FiO2
Answer: C
Rationale: Oxygen alone is insufficient for shunt-related hypoxemia; mechanical ventilation is typically required.
46
What type of ARF is most commonly seen in opioid overdose?
A. Hypoxemic
B. Hypercapnic
C. Shunt-related
D. Diffusion-limited
Answer: B
Rationale: Opioids suppress the respiratory center in the brain, leading to CO2 retention and hypercapnia.
47
Which symptom is an early sign of hypoxemic respiratory failure?
A. Cyanosis
B. Decreased LOC
C. Clubbing
D. Bradycardia
Answer: B
Rationale: The brain is highly sensitive to hypoxia; confusion and agitation are early signs.
48
What breathing pattern may indicate impending respiratory arrest?
A. Pursed-lip breathing
B. Kussmaul respirations
C. Slow, shallow breathing after rapid rate
D. Accessory muscle use
Answer: C
Rationale: A slowing respiratory rate in a previously tachypneic patient suggests muscle fatigue.
49
What is the primary goal of O2 therapy in ARF?
A. Keep PaO2 > 50 mm Hg
B. Maintain FiO2 at 100%
C. Maintain PaO2 ≥ 60 mm Hg and SaO2 ≥ 90%
D. Keep RR < 20 bpm
Answer: C
Rationale: Target oxygenation goals for ARF are PaO2 ≥ 60 mm Hg and SaO2 ≥ 90%.
50
Which patient is at greatest risk for ARF?
A. A healthy 28-year-old athlete
B. A 60-year-old with COPD and pneumonia
C. A 45-year-old with GERD
D. A 30-year-old with anxiety
Answer: B
Rationale: COPD combined with pneumonia increases the risk for both hypoxemic and hypercapnic respiratory failure.
51
A patient with ARF is using tripod positioning. What does this indicate?
A. Mild hypoxia
B. Hypercapnia
C. Moderate to severe respiratory distress
D. Pain-related shallow breathing
Answer: C
Rationale: Tripod positioning reduces work of breathing in patients with significant distress.
52
What is the hallmark sign of diffusion limitation?
A. Wheezing at rest
B. Fine crackles
C. Hypoxemia that worsens with exercise
D. Clubbing of the fingers
Answer: C
Rationale: Diffusion limitation causes worsening gas exchange with increased activity due to reduced transit time.
53
Which respiratory therapy improves gas exchange in shunt-related ARF?
A. Incentive spirometry
B. Nebulized bronchodilators
C. Non-invasive ventilation (BiPAP)
D. Mechanical ventilation with PEEP
Answer: D
Rationale: Positive pressure ventilation, including PEEP, helps open alveoli and improve gas exchange during shunting.
54
A patient in ARF with a pH of 7.28 and PaCO2 of 56 mm Hg is experiencing:
A. Respiratory alkalosis
B. Metabolic acidosis
C. Respiratory acidosis
D. Normal acid-base balance
Answer: C
Rationale: Elevated PaCO2 and low pH indicate uncompensated respiratory acidosis.
55
What is the most accurate way to evaluate ventilation in ARF?
A. SpO2
B. Chest x-ray
C. Respiratory rate
D. ABGs
Answer: D
Rationale: ABG analysis directly measures PaCO2, PaO2, and pH, providing the most accurate picture of ventilation.
56
Which sign is considered a late indicator of hypoxemia?
A. A. Restlessness
B. B. Cyanosis
C. C. Tachypnea
D. D. Dyspnea
Answer: B. Cyanosis
Rationale: Cyanosis is a late and unreliable sign of hypoxemia; it indicates severe deoxygenation.
57
Which positioning is best to promote oxygenation in a patient with ARF and right-sided pneumonia?
A. A. Supine
B. B. Right side-lying
C. C. Left side-lying
D. D. Prone
Answer: C. Left side-lying
Rationale: "Good lung down" promotes better perfusion. Lying on the left optimizes oxygenation from the unaffected lung.
58
What is the best nursing intervention to prevent oxygen toxicity?
A. A. Administer oxygen at 100% for all ARF patients
B. B. Use high-flow oxygen for long durations
C. C. Use the lowest FiO2 needed to maintain target saturation
D. D. Avoid humidified oxygen
Answer: C. Use the lowest FiO2 needed to maintain target saturation
Rationale: To avoid oxygen toxicity, deliver the minimum amount needed to reach therapeutic goals (PaO2 ≥ 60 mm Hg, SaO2 ≥ 90%).
59
Which condition causes hypercapnic respiratory failure by impairing chest wall movement?
A. A. Asthma
B. B. Obesity
C. C. Pulmonary embolism
D. D. Pneumonia
Answer: B. Obesity
Rationale: Severe obesity restricts chest wall expansion, contributing to ventilatory failure and CO2 retention.
60
Which breathing technique helps prevent small airway collapse during exhalation?
A. A. Staged coughing
B. B. Huff coughing
C. C. Incentive spirometry
D. D. Pursed-lip breathing
Answer: D. Pursed-lip breathing
Rationale: Pursed-lip breathing prolongs exhalation, helps prevent airway collapse, and improves gas exchange.
61
Which electrolyte imbalance is most likely in a patient with ARF and lactic acidosis?
A. A. Hypocalcemia
B. B. Hyperkalemia
C. C. Hyponatremia
D. D. Hypokalemia
Answer: B. Hyperkalemia
Rationale: Acidosis causes hydrogen ions to enter cells and potassium to move out, raising serum potassium levels.
62
What ABG result would you expect with hypoventilation?
A. A. Low PaCO2
B. B. High PaO2
C. C. High PaCO2
D. D. Normal pH
Answer: C. High PaCO2
Rationale: Hypoventilation results in CO2 retention, leading to elevated PaCO2 (hypercapnia).
63
Which respiratory pattern is common in ARF due to metabolic acidosis?
A. A. Kussmaul respirations
B. B. Apnea
C. C. Cheyne-Stokes
D. D. Bradypnea
Answer: A. Kussmaul respirations
Rationale: Kussmaul respirations are deep and rapid, compensating for metabolic acidosis by blowing off CO2.
64
In which case is non-invasive ventilation (BiPAP) most appropriate?
A. A. Cardiac arrest
B. B. Apneic episode
C. C. Alert COPD patient with dyspnea
D. D. Unconscious trauma patient
Answer: C. Alert COPD patient with dyspnea
Rationale: BiPAP is best for alert, cooperative patients with mild to moderate ARF and intact airway reflexes.
65
Which of the following is a common auscultatory finding in pulmonary edema?
A. A. Stridor
B. B. Fine crackles
C. C. Wheezing
D. D. Pleural friction rub
Answer: B. Fine crackles
Rationale: Fine crackles suggest fluid in the alveoli, a classic finding in pulmonary edema.
66
What is a primary consequence of anaerobic metabolism in ARF?
A. A. Hypoglycemia
B. B. Lactic acidosis
C. C. Respiratory alkalosis
D. D. Hypernatremia
Answer: B. Lactic acidosis
Rationale: Anaerobic metabolism produces lactic acid, leading to metabolic acidosis if uncorrected.
67
Which device delivers the most precise FiO2 in oxygen therapy?
A. A. Simple face mask
B. B. Nasal cannula
C. C. Non-rebreather mask
D. D. Venturi mask
Answer: D. Venturi mask
Rationale: The Venturi mask offers precise control over FiO2 levels, making it ideal for CO2 retainers like COPD patients.
68
What is the best indicator that ARF treatment is working?
A. A. Normal lung sounds
B. B. Improved ABG values
C. C. Absence of accessory muscle use
D. D. Ability to speak in full sentences
Answer: B. Improved ABG values
Rationale: ABGs objectively measure improvements in gas exchange and ventilation.
69
In which patient would you expect to find paradoxical breathing?
A. A. Mild asthma
B. B. ARF with severe fatigue
C. C. COPD with pursed-lip breathing
D. D. Restrictive lung disease
Answer: B. ARF with severe fatigue
Rationale: Paradoxical breathing results from maximal use of accessory muscles during severe respiratory distress.
70
Which sign suggests worsening hypercapnia in a patient with ARF?
A. A. Morning headache
B. B. Bradypnea
C. C. Clear lung sounds
D. D. Hypotension
Answer: A. Morning headache
Rationale: A morning headache is an early sign of elevated CO2 levels and potential respiratory acidosis.
71
What is the primary purpose of chest physiotherapy in ARF?
A. A. Reduce fever
B. B. Treat infection
C. C. Mobilize secretions
D. D. Prevent pneumothorax
Answer: C. Mobilize secretions
Rationale: Chest physiotherapy helps move secretions into larger airways for removal, improving ventilation.
72
Which intervention is appropriate before starting mechanical ventilation in ARF?
A. A. Place patient in prone position
B. B. Obtain ABGs
C. C. Insert Foley catheter
D. D. Administer bronchodilator
Answer: B. Obtain ABGs
Rationale: ABGs are essential to evaluate the need for ventilation and the severity of gas exchange abnormalities.
72
Which nursing assessment is the priority in a newly diagnosed ARF patient?
A. A. Peripheral pulses
B. B. Bowel sounds
C. C. Airway and breathing
D. D. Capillary refill
Answer: C. Airway and breathing
Rationale: Maintaining a patent airway and effective breathing is always the top priority in ARF.
73
Which of the following indicates improvement in respiratory function?
A. A. Increased WOB
B. B. SpO2 rising to 95%
C. C. Use of accessory muscles
D. D. Retractions
Answer: B. SpO2 rising to 95%
Rationale: A rise in oxygen saturation indicates improved gas exchange and therapy effectiveness.
74
What is the first sign of increased WOB in ARF?
A. A. Tripod positioning
B. B. Use of accessory muscles
C. C. Cyanosis
D. D. Paradoxical breathing
Answer: B. Use of accessory muscles
Rationale: Accessory muscle use indicates the body is working harder to maintain ventilation and oxygenation.
75
A hallmark sign of ARDS is:
A. Productive cough
B. Refractory hypoxemia
C. Low-grade fever
D. Bradypnea
Answer: B. Refractory hypoxemia
Rationale: Refractory hypoxemia means low oxygen levels that do not improve with increased oxygen delivery—a key indicator of ARDS.
76
The most common direct cause of ARDS is:
A. Sepsis
B. Near-drowning
C. Aspiration
D. Pancreatitis
Answer: C. Aspiration
Rationale: Aspiration is the most common direct cause of ARDS, leading to immediate lung inflammation.
77
Which phase of ARDS occurs within 24–72 hours of injury?
A. Reparative
B. Exudative
C. Fibrotic
D. Latent
Answer: B. Exudative
Rationale: The exudative phase begins 24–72 hours after the initial injury, involving alveolar damage and pulmonary edema.
78
In the fibrotic stage of ARDS, the primary change is:
A. Increased surfactant production
B. Decreased respiratory rate
C. Lung scarring and fibrosis
D. Alveolar hemorrhage
Answer: C. Lung scarring and fibrosis
Rationale: Fibrosis and collagen remodeling reduce lung compliance and gas exchange.
78
Which diagnostic test helps distinguish ARDS severity?
A. BNP
B. PaCO2/PaO2 ratio
C. PaO2/FIO2 ratio
D. Serum lactate
Answer: C. PaO2/FIO2 ratio
Rationale: A P/F ratio below 300 suggests ARDS, with <100 indicating severe ARDS.
79
What finding on a chest x-ray is most consistent with ARDS?
A. Cardiomegaly
B. Pleural effusion
C. Bilateral infiltrates or "whiteout"
D. Unilateral lung opacity
Answer: C. Bilateral infiltrates or "whiteout"
Rationale: "Whiteout" appearance indicates diffuse alveolar damage and fluid accumulation.
80
What intervention is commonly used for ARDS with refractory hypoxemia?
A. Lateral positioning
B. Supine positioning
C. Prone positioning
D. Fowler’s position
Answer: C. Prone positioning
Rationale: Prone positioning improves ventilation-perfusion matching and oxygenation.
81
What is a risk factor for barotrauma in ARDS patients?
A. Low FIO2
B. Large tidal volumes during mechanical ventilation
C. Ambulation
D. Chest physiotherapy
Answer: B. Large tidal volumes during mechanical ventilation
Rationale: High tidal volumes can rupture fragile alveoli, causing barotrauma.
82
The preferred tidal volume for a patient with ARDS on mechanical ventilation is:
A. 10–12 mL/kg
B. 8–10 mL/kg
C. 4–8 mL/kg
D. 2–4 mL/kg
Answer: C. 4–8 mL/kg
Rationale: Low tidal volume ventilation prevents ventilator-induced lung injury.
83
Which complication of ARDS is associated with decreased perfusion to the kidneys?
A. Liver failure
B. Myocardial infarction
C. Acute kidney injury (AKI)
D. Deep vein thrombosis
Answer: C. Acute kidney injury (AKI)
Rationale: Hypotension and hypoxemia impair renal perfusion, leading to AKI.
84
Which ventilator setting helps prevent alveolar collapse in ARDS?
A. FIO2
B. PEEP
C. RR
D. Tidal volume
Answer: B. PEEP (Positive End-Expiratory Pressure)
Rationale: PEEP maintains alveolar inflation and improves oxygenation.
85
Which drug class is commonly used to prevent GI ulcers in ARDS patients?
A. Beta-blockers
B. Proton pump inhibitors
C. Antiemetics
D. Antitussives
Answer: B. Proton pump inhibitors
Rationale: PPIs reduce stomach acid and prevent stress ulcers in critically ill patients.
86
What physical sign may indicate early ARDS?
A. Bradycardia
B. Cyanosis
C. Restlessness and tachypnea
D. Abdominal pain
Answer: C. Restlessness and tachypnea
Rationale: Restlessness is an early sign of hypoxia; tachypnea indicates increased work of breathing.
87
The purpose of prone positioning in ARDS is to:
A. Increase cardiac output
B. Improve lymphatic drainage
C. Enhance ventilation to posterior alveoli
D. Prevent aspiration
Answer: C. Enhance ventilation to posterior alveoli
Rationale: Prone positioning recruits collapsed alveoli in the dorsal lung regions.
88
What ABG result would you expect in early ARDS?
A. Metabolic alkalosis
B. Respiratory acidosis
C. Normal ABG
D. Respiratory alkalosis
Answer: D. Respiratory alkalosis
Rationale: Tachypnea in early ARDS causes CO2 washout, resulting in respiratory alkalosis.
89
What is a common cause of indirect ARDS?
A. Smoke inhalation
B. Pancreatitis
C. Near drowning
D. Aspiration
Answer: B. Pancreatitis
Rationale: Pancreatitis is an indirect cause due to systemic inflammation affecting the lungs.
90
The nurse suspects VAP in an ARDS patient if:
A. ABGs improve
B. There is increased WBCs, fever, and purulent sputum
C. The ventilator alarm sounds
D. The PaO2 increases
Answer: B. There is increased WBCs, fever, and purulent sputum
Rationale: These are classic signs of ventilator-associated pneumonia.
91
A major long-term complication of ARDS is:
A. Hypertension
B. Pulmonary fibrosis
C. Gastritis
D. Deep vein thrombosis
Answer: B. Pulmonary fibrosis
Rationale: Fibrotic remodeling of lung tissue leads to chronic respiratory limitations.
92
Which electrolyte imbalance may occur due to nephrotoxic drugs in ARDS?
A. Hypocalcemia
B. Hypermagnesemia
C. Hyperkalemia
D. Hypokalemia
Answer: C. Hyperkalemia
Rationale: AKI from nephrotoxins can impair potassium excretion.
93
Which drug may be used to decrease pulmonary capillary permeability in ARDS?
A. Methylprednisolone
B. Vasopressin
C. Furosemide
D. Acetylcysteine
Answer: A. Methylprednisolone
Rationale: Corticosteroids may help reduce inflammation and capillary leak.
94
Which patient is most at risk for developing ARDS?
A. A patient with asthma using a bronchodilator
B. A patient post-op hip replacement with no complications
C. A patient with sepsis and hypotension
D. A patient with controlled hypertension
Answer: C. A patient with sepsis and hypotension
Rationale: Sepsis is the most common cause of ARDS, especially with accompanying hypotension.
95
What is the primary goal of oxygen therapy in ARDS?
A. Eliminate CO2 completely
B. Prevent barotrauma
C. Maintain PaO2 ≥ 60 mm Hg
D. Increase respiratory rate
Answer: C. Maintain PaO2 ≥ 60 mm Hg
Rationale: The goal is to improve oxygenation while avoiding oxygen toxicity.
96
Which intervention helps reduce the risk of VTE in ARDS patients?
A. Increasing FIO2
B. Prone positioning
C. Sequential compression devices
D. Administering antibiotics
Answer: C. Sequential compression devices
Rationale: Immobility in ARDS increases risk for DVT; SCDs promote venous return.
97
The nurse suspects barotrauma if the ARDS patient develops:
A. Diminished breath sounds and sudden hypotension
B. Bradycardia
C. Productive cough
D. Hyperthermia
Answer: A. Diminished breath sounds and sudden hypotension
Rationale: Barotrauma (like pneumothorax) causes sudden symptoms such as absent lung sounds and hypotension.
98
In the exudative phase of ARDS, what causes hypoxemia?
A. Increased lung elasticity
B. Fluid-filled alveoli and shunting
C. Hyperinflated lungs
D. Bronchospasm
Answer: B. Fluid-filled alveoli and shunting
Rationale: Alveolar damage and fluid accumulation impair gas exchange and lead to shunting.
99
Which lab trend should the nurse monitor to assess for AKI in ARDS?
A. AST/ALT
B. Platelets
C. Creatinine
D. Troponin
Answer: C. Creatinine
Rationale: Creatinine is a key indicator of renal function and a marker for AKI.
100
Permissive hypercapnia in ARDS is used to:
A. Prevent acidosis
B. Allow for lower tidal volumes
C. Promote mucous clearance
D. Increase respiratory rate
Answer: B. Allow for lower tidal volumes
Rationale: Permissive hypercapnia helps avoid ventilator-induced lung injury by tolerating higher CO2.
101
The nurse evaluates improvement in an ARDS patient if:
A. P/F ratio decreases
B. Lung infiltrates worsen
C. PaO2 increases with stable FIO2
D. Tachypnea increases
Answer: C. PaO2 increases with stable FIO2
Rationale: Rising PaO2 without needing more oxygen suggests improved oxygenation.
102
Which strategy helps prevent GI ulcers in patients with ARDS?
A. Restricting fluids
B. Administering sucralfate
C. Elevating the foot of the bed
D. Using incentive spirometry
Answer: B. Administering sucralfate
Rationale: Sucralfate protects the GI lining, reducing the risk of stress ulcers.
103
The hallmark ABG change in late ARDS is:
A. Mixed acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Compensated respiratory alkalosis
Answer: A. Mixed acidosis
Rationale: Late ARDS leads to both respiratory and metabolic acidosis due to impaired gas exchange and anaerobic metabolism.
104
Which of the following describes the use of PEEP in ARDS?
A. Promotes hyperventilation
B. Reduces lung compliance
C. Prevents alveolar collapse
D. Decreases pulmonary edema
Answer: C. Prevents alveolar collapse
Rationale: PEEP keeps alveoli open at end-expiration, improving oxygenation.
105
Why are corticosteroids sometimes used in ARDS?
A. To prevent infection
B. To sedate the patient
C. To reduce inflammation
D. To lower blood pressure
Answer: C. To reduce inflammation
Rationale: Steroids may decrease inflammatory response and capillary leak in some patients.
106
An early sign of decreased lung compliance in ARDS is:
A. Wheezing
B. Use of accessory muscles
C. Loud bowel sounds
D. Polyuria
Answer: B. Use of accessory muscles
Rationale: As lungs stiffen, patients must use extra muscles to breathe effectively.
107
Why is enteral nutrition preferred in ARDS?
A. Reduces glucose spikes
B. Prevents nausea
C. Increases potassium
D. Helps prevent GI mucosal breakdown
Answer: D. Helps prevent GI mucosal breakdown
Rationale: EN maintains gut integrity and prevents bacterial translocation.
108
What finding would suggest prone positioning is effective in an ARDS patient?
A. PaO2 increases
B. Heart rate increases
C. FIO2 requirements increase
D. Blood pressure drops
Answer: A. PaO2 increases
Rationale: Improved oxygenation indicates better gas exchange and lung recruitment.
