Complex Care Problem Solving Exam
Questions and With Distinction level Marking
scheme updated 2024/2025
Augmented coughing (nursing management acute respiratory failure) - correct answer •Place
one or both hands on the base of the lungs
•At the beginning of expiration, move the hand(s) forcefully upward
Huff coughing (nursing management acute respiratory failure) - correct answer •Series of
coughs performed while saying "huff"
•Effective in clearing central airways
Staged coughing (nursing management acute respiratory failure) - correct answer •Sit leaning
forward
•Take three deep breaths through mouth and cough
Nursing management acute respiratory failure - correct answer •Hydration and humidification
•Adequate fluid intake
•IV hydration
•Humidification devices
•O2 via aerosol mask
•Mucolytic drugs
•Chest physiotherapy
•Postural drainage
•Percussion
•Vibration
•Airway suctioning
•Nasopharyngeal
•Oropharyngeal
•Nasotracheal
,•Respiratory therapy
•Positive pressure ventilation (PPV)
•Noninvasive PPV
•bipap
•CPAP
Drug therapy acute respiratory failure - correct answer •Drug therapy
•Relief of bronchospasm
•Bronchodilators
•Reduction of airway inflammation
•Corticosteroids
•Reduction of pulmonary congestion
•Diuretics, nitrates if heart failure present
•Treatment of pulmonary infections
•IV antibiotics
•Reduction of severe anxiety, pain, and agitation
•Benzodiazepines (watch closely due to respiratory depression)
•Opioids (watch closely due to respiratory depression)
Acute respritory distress syndrome (ARDS) - correct answer •Sudden, progressive form of
respiratory failure
•Alveolar capillary membrane becomes damaged and are more permeable to intravascular fluid
•Severe dyspnea, hypoxemia refractory to supplemental O2
•High mortality rates (50%)
•Patients with gram-negative shock and ARDS even higher mortality rates (70-90%)
Injury/Exudative Phase (ARDS) - correct answer •1-7 hours after lung injury or insult
•Neutrophils
Reparative (proliferative) phase of ARDS - correct answer •1-2 weeks after injury or insult
,•Fibroblasts
Fibrotic phase ARDS - correct answer •2-3 weeks after injury or insult
•Collagenous and fibrous tissues (decreases ability for gas exchange -> permanent damage)
Risks for ARDS - correct answer •Common Causes
•Sepsis
•Aspiration of gastric contents
•Pneumonia
•Severe massive trauma
•Less Common
•Chest trauma
•Embolism
•Near drowning
•O2 toxicity
•Acute pancreatitis
•Anaphylaxis
•Severe head injury
Clinical manifestations of ARDS - correct answer •Hypoxemia is hallmark despite O2
administration
•Tachypnea
•Intercostal and suprasternal retractions
•Diaphoresis
•Mental status changes
•Cyanosis
•Pallor
•Hypercapnia
•Target organ dysfunction
, Early clinical manifestations of ARDS - correct answer •Dyspnea, tachypnea, cough,
restlessness
•Chest auscultation may be normal or may reveal fine, scattered crackles
•abgs
•Mild hypoxemia and respiratory alkalosis caused by hyperventilation
•Chest x-ray may be normal or reveal minimal scattered interstitial infiltrates
•Edema may not show until 30% increase in fluid content in the lungs
Late clinical manifestations of ARDS - correct answer •Symptoms worsen with increased fluid
accumulation and decreased lung compliance
•Pulmonary function tests reveal decreased compliance, lung volumes, and functional residual
capacity (FRC)
•Tachycardia, diaphoresis, changes in mental status, cyanosis, and pallor
•Diffuse crackles and coarse crackles
•Hypoxemia despite increased FIO2
•Increasing WOB despite initial findings of normal pao2 or sao2
Progression of ARDS - correct answer •profound respiratory distress requires endotracheal
intubation and PPV (positive pressure ventilation)
•Chest x-ray termed whiteout or white lung because of consolidation and widespread infiltrates
throughout lungs
•Leaves few recognizable air spaces
Complications of ARDS - correct answer •Ventilator-associated pneumonia (VAP)
•Barotrauma
•Rupture of overdistended alveoli during mechanical ventilation
•Volutrauma
•Occurs when large tidal volumes are used to ventilate noncompliant lungs
•Stress ulcers
•Bleeding from stress ulcers occurs in 30% of patients with ARDS on mechanical ventilation
•Renal failure
Questions and With Distinction level Marking
scheme updated 2024/2025
Augmented coughing (nursing management acute respiratory failure) - correct answer •Place
one or both hands on the base of the lungs
•At the beginning of expiration, move the hand(s) forcefully upward
Huff coughing (nursing management acute respiratory failure) - correct answer •Series of
coughs performed while saying "huff"
•Effective in clearing central airways
Staged coughing (nursing management acute respiratory failure) - correct answer •Sit leaning
forward
•Take three deep breaths through mouth and cough
Nursing management acute respiratory failure - correct answer •Hydration and humidification
•Adequate fluid intake
•IV hydration
•Humidification devices
•O2 via aerosol mask
•Mucolytic drugs
•Chest physiotherapy
•Postural drainage
•Percussion
•Vibration
•Airway suctioning
•Nasopharyngeal
•Oropharyngeal
•Nasotracheal
,•Respiratory therapy
•Positive pressure ventilation (PPV)
•Noninvasive PPV
•bipap
•CPAP
Drug therapy acute respiratory failure - correct answer •Drug therapy
•Relief of bronchospasm
•Bronchodilators
•Reduction of airway inflammation
•Corticosteroids
•Reduction of pulmonary congestion
•Diuretics, nitrates if heart failure present
•Treatment of pulmonary infections
•IV antibiotics
•Reduction of severe anxiety, pain, and agitation
•Benzodiazepines (watch closely due to respiratory depression)
•Opioids (watch closely due to respiratory depression)
Acute respritory distress syndrome (ARDS) - correct answer •Sudden, progressive form of
respiratory failure
•Alveolar capillary membrane becomes damaged and are more permeable to intravascular fluid
•Severe dyspnea, hypoxemia refractory to supplemental O2
•High mortality rates (50%)
•Patients with gram-negative shock and ARDS even higher mortality rates (70-90%)
Injury/Exudative Phase (ARDS) - correct answer •1-7 hours after lung injury or insult
•Neutrophils
Reparative (proliferative) phase of ARDS - correct answer •1-2 weeks after injury or insult
,•Fibroblasts
Fibrotic phase ARDS - correct answer •2-3 weeks after injury or insult
•Collagenous and fibrous tissues (decreases ability for gas exchange -> permanent damage)
Risks for ARDS - correct answer •Common Causes
•Sepsis
•Aspiration of gastric contents
•Pneumonia
•Severe massive trauma
•Less Common
•Chest trauma
•Embolism
•Near drowning
•O2 toxicity
•Acute pancreatitis
•Anaphylaxis
•Severe head injury
Clinical manifestations of ARDS - correct answer •Hypoxemia is hallmark despite O2
administration
•Tachypnea
•Intercostal and suprasternal retractions
•Diaphoresis
•Mental status changes
•Cyanosis
•Pallor
•Hypercapnia
•Target organ dysfunction
, Early clinical manifestations of ARDS - correct answer •Dyspnea, tachypnea, cough,
restlessness
•Chest auscultation may be normal or may reveal fine, scattered crackles
•abgs
•Mild hypoxemia and respiratory alkalosis caused by hyperventilation
•Chest x-ray may be normal or reveal minimal scattered interstitial infiltrates
•Edema may not show until 30% increase in fluid content in the lungs
Late clinical manifestations of ARDS - correct answer •Symptoms worsen with increased fluid
accumulation and decreased lung compliance
•Pulmonary function tests reveal decreased compliance, lung volumes, and functional residual
capacity (FRC)
•Tachycardia, diaphoresis, changes in mental status, cyanosis, and pallor
•Diffuse crackles and coarse crackles
•Hypoxemia despite increased FIO2
•Increasing WOB despite initial findings of normal pao2 or sao2
Progression of ARDS - correct answer •profound respiratory distress requires endotracheal
intubation and PPV (positive pressure ventilation)
•Chest x-ray termed whiteout or white lung because of consolidation and widespread infiltrates
throughout lungs
•Leaves few recognizable air spaces
Complications of ARDS - correct answer •Ventilator-associated pneumonia (VAP)
•Barotrauma
•Rupture of overdistended alveoli during mechanical ventilation
•Volutrauma
•Occurs when large tidal volumes are used to ventilate noncompliant lungs
•Stress ulcers
•Bleeding from stress ulcers occurs in 30% of patients with ARDS on mechanical ventilation
•Renal failure
