ARDS & ARF QUESTIONS WITH SOLUTIONS

ARDS & ARF QUESTIONS WITH SOLUTIONS The nurse is planning care for a client with ARDS. The nurse knows that the overall goal for the client should include: a. Pao2 of less than 50 mm Hg b. Pulmonary wedge pressure of less than or equal to 18 mm Hg c. Sao2 equal to 90% d. Pao2 of at least 60 mm Hg Occasionally clients with acute respiratory distress syndrome (ARDS) are placed in the prone position. How does this position help the client? a. It improved cardiac output b. It makes the client more comfortable c. It prevents skin breakdown d. It recruits more alveoli The nurse is taking care of a client who has Acute Respiratory Distress Syndrome. The nurse understands that the primary pathophysiologic changes that occur in the injury or exudative phase of ARDS are: (select all that apply) a. Atelectasis b. Hyaline membranes line the alveoli c. Interstitial and alveolar edema d. Influx of neutrophils, monocytes and lymphocytes A 71-year-old client is admitted to the unit with a diagnosis of ARDS. Which indication for ventilator support for ARDS is inappropriate? a. O2 saturation greater than 90% b. PaO2 greater than 60% c. Respiratory rate greater than 35 breathes pm. ?? d. Vital capacity equal to 60 mL/kg of body weight. The nurse is caring for a client who has ARDS who is intubated and on mechanical ventilation. The oxygen concentration is set at 80%, tidal volume 700 with a PEEP of 12. The purpose of these settings is to a. Keep the alveoli open so that oxygenation has a longer time to take place ?? b. Decrease the amount of carbon dioxide present in arterial blood c. Prevent the formation of pulmonary emboli and improve d. improve lung compliance and prevent congestion The nurse recognizes that the primary pathological problem that initiates the pulmonary changes that occur in ARDS is a. Injury to the brachial lining of the lungs b. Increased production of surfactant c. Remodeling of the lung fibrous tissue d. Disruption of the capillary endothelium The nurse assesses that client in respiratory distress is developing respiratory fatigue and the risk of respiratory arrest when the client a. Has an increased I/E ratio b. Cannot breathe unless he is sitting upright c. Uses the abdominal muscles during expiration d. has a change in respiratory rate from rapid to slow A client is short of breath and restless. The nurse during her assessment observes that the most common early clinical manifestation of ARDS that the nurse may observe are a. Dyspnea and tachypnea or tachycardia b. Hypotension and tachycardia ???? c. Cyanosis and apprehension d. Respiratory distress and frothy sputum The physician is considering weaning a client with ARDS off the ventilator. The nurse knows that arterial blood gas measurement that best reflects the adequacy of alveolar ventilation is the: a. PaO2 b. PaCO2 c. pH d. SaO2 A patient who is a 35-year-old basketball player is intubated due to ARDS following a hemorrhagic reaction due to shock. One of the complications of ARDS is the stiffening of the lungs causing a. capillary leak syndrome. b. "white out" shown by chest x-rays. c. wet lungs syndrome. d. hyaline membrane formation. A patient in respiratory distress is admitted to the medical unit at the hospital. During the initial assessment of the patient, the nurse should a. obtain a comprehensive health history to determine the extent of any prior respiratory problems. b. complete a full physical examination to determine the systemic effect of the respiratory distress. c. delay the physical assessment and ask family members about any history of respiratory problems. d. perform a respiratory system assessment and ask specific questions about this episode of respiratory distress. A finding indicating to the nurse that a 22-year-old patient with respiratory distress is in acute respiratory failure includes a a. shallow breathing pattern. b. partial pressure of arterial oxygen (PaO2) of 45 mm Hg. c. partial pressure of carbon dioxide in arterial gas (PaCO2) of 34 mm Hg. d. respiratory rate of 32/min. b. partial pressure of arterial oxygen (PaO2) of 45 mm Hg. A patient who has acute respiratory distress syndrome is receiving treatment with the use of a mechanical ventilator and supportive breathing techniques. Which of the following is the most important technique for this patient? a. Tidal volume. b. Expiratory volume. c. Positive end expiratory pressure. d. Inspiratory volume. c. Positive end expiratory pressure. The nurse has identified fatigue as an appropriate nursing diagnosis for a client with respiratory distress secondary to pneumonia. Which of the following is an appropriate etiology for this nursing diagnosis? a. presence of endotracheal tube and mechanical ventilation b. pneumonia c. high PEEP settings d. interruption of sleep-wake cycle. b. pneumonia Which information obtained by the nurse when assessing a patient with acute respiratory distress syndrome (ARDS) who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP) indicates a complication of ventilator therapy is occurring? a. The patient has subcutaneous emphysema. b. The patient has a sinus bradycardia, rate 52. c. The patient's PaO2 is 50 mm Hg and the SaO2 is 88%. d. The patient has bronchial breath sounds in both the lung fields. a. The patient has subcutaneous emphysema. The nurse has established a nursing diagnosis of impaired gas exchange for a client with acute respiratory distress syndrome (ARDS). The patient is on a mechanical ventilator. Which of the following is an appropriate nursing intervention for this nursing diagnosis for this patient? a. monitor peripheral pulses q 2 hours b. administer antibiotic as ordered c. suction patient as needed d. increase positive end expiratory pressure (PEEP) to keep PaO2 greater than 50% d. increase positive end expiratory pressure (PEEP) to keep PaO2 greater than 50% In patients with ARDS who survive the acute phase of lung injury, what manifestations should alert the nurse that the patient has progressed to the fibrotic phase? a. Chronic pulmonary edema and atelectasis. b. Continued hypoxemia because of diffusion limitation. because lungs are getting stiffer and oxygen exchange cannot happen c. Resolution of edema and healing of lung tissue. d. Increased lung compliance caused by the breakdown of fibrotic tissue. b. Continued hypoxemia because of diffusion limitation. because lungs are getting stiffer and oxygen Which of these nursing actions included in the care of a mechanically ventilated client with acute respiratory distress syndrome ( ARDS) is most appropriate for the RN to delegate to an experienced LPN / LVN working in the intensive care unit? a. Placing the client in the prone position. b. Assessment of client breath sounds. c. Administration of enteral tube feedings d. Obtaining the pulmonary artery pressures c. Administration of enteral tube feedings A 71year- old client is admitted to the unit with a diagnosis of Acute Respiratory Distress Syndrome ( ARDS). Which indication for ventilator support for ARDS is inappropriate? a. O2 saturation greater than 90% b. PaO2 greater than 60% c. Respiratory rate greater than 35 breathes pm. d. Vital capacity equal to 60 mL/kg of body weight a. O2 saturation greater than 90% The nurse recognizes that the primary pathological problem that initiates the pulmonary changes that occur in ARDS is: a. Injury to the bronchial lining of the lungs. b. Increased production of surfactant. c. Remodeling of the lung fibrous tissue. d. Disruption of the capillary endothelium d. Disruption of the capillary endothelium A patient with acute respiratory distress syndrome (ARDS) has progressed to the fibrotic phase. The patient's family members are anxious about the patient's condition and are continuously present at the hospital. In addressing the family's concerns, it is important for the nurse to a. support the family and help them understand the realistic expectation that the patient's chance for survival is poor. b. inform the family that home health nurses will be able to help them maintain the mechanical ventilation at home after patient discharge. c. refer the family to social support services and case management to plan for transfer of the patient to a long-term care facility. d. provide hope and encouragement to the family because the patient's disease process has started to resolve. a. support the family and help them understand the realistic expectation that the patient's chance for survival is poor. A patient with ARDS who is on ventilation therapy has a nursing diagnosis of imbalanced nutrition related to decreased energy level with increased caloric requirement. Initially the nurse should a. provide nourishment to the patient b. determine in collaboration with the dietician the number of calories and type of nutrients needed. c. administer parenteral feeding d. weigh patient daily b. determine in collaboration with the dietician the number of calories and type of nutrients needed. A client in respiratory distress is admitted to the medical unit . During the initial assessment of the client, the nurse should a. obtain a comprehensive health history b. complete a full physical examination c. delay the physical assessment and ask family members about any history of respiratory problems d. ask specific questions about this episode of respiratory distress d. ask specific questions about this episode of respiratory distress