N432 EXAM 1 DAVIS EDGE
Thebnchargebnnursebnisbnrevisingbnthebnventilatedbnpatientsbninbnthebnintensivebncarebnunitbnforbntheirb
nriskbnofbndevelopingbnacutebnrespiratorybndistressbnsyndromebn(ARDS).bnWhichbnpatientsbnshouldbnbeb
nmostbncloselybnmonitoredbnforbnsymptoms?bnSelectbnallbnthatbnapply.bn-bnanswers--
*bn88bnyearbnoldbnwithbnaspirationbnpneumoniabnafterbnabnstrokebn(aspirationbnisbnabnhighbnriskbnforbnA
RDSbndevelopment)
*bn19bnyearbnoldbninvolvedbninbnabnmulti-
carbnaccidentbn(severebntraumabnsuchbnasbnabncarbnaccidentbnisbnabnriskbnfactorbnforbnARDS)
*bn45bnyearbnoldbnwhobnhadbnabnfive-
vesselbncoronarybnbypassbngraftbnsurgerybn(thosebnwhobnhavebnbeenbnonbncardiopulmonarybnbypassbna
rebnatbnrisk)
xbn54bnyearbnoldbnwithbnabncolostomybnfrombndiverticulitisbn(abdominalbnsurgeriesbnarebnnotbnhigherbnr
isk,bnunlessbninbnthebnpresencebnofbnsepsis)
*bn62bnyearbnoldbnwithbnabnleftbnlobebnremovalbnfrombnlungbncancerbn(abnpneumonectomybnisbnabnriskb
nfactor)
Thebnnursebnisbncaringbnforbnabnpatientbnwithbnanbnincreasedbnriskbnforbndevelopingbnacutebnrespirator
ybndistressbnsyndromebn(ARDS).bnCalculatebnthebnARDSbnratiobnifbnthebnpatient'sbnPaO2bnisbn70bnonbnan
bnFiO2bnofbn60%.bnRoundbntobnthebnnearestbnwholebnnumber.bnEnterbnnumeralbnonly.
Answer
CorrectbnAnswer:bn117
Rationale:bnTobncalculatebnthebnARDSbnratio,bndividebnthebnPaO2bnbybnthebnpercentbnofbnFiO2.bn70/0.60
bn=bn116.6bn=bn117bn-bnanswers--tobncalculatebnthebnARDSbnratio,bn70/0.60bn=bn117
Thebnnursebnisbncaringbnforbnabnpatientbnwithbnacutebnrespiratorybndistressbnsyndromebnwithbnabnseveri
tybnratiobnofbn101bnonbnpositivebnend-
expiratorybnpressurebn(PEEP).bnWhatbncategorybnofbnseveritybnisbnthisbnpatient?bn-bnanswers--
moderate.
xbnMild
, Rationale:bnThisbnisbnabnseveritybnratiobnofbn200-
300bnonbnventilatorbnsettingsbnthatbnincludebnpositivebnend-
expiratorybnpressurebn(PEEP)bnorbncontinuousbnpositivebnairwaybnpressurebn(CPAP).
*bnModerate
Rationale:bnThisbnisbnabnseveritybnratiobnofbn100-200bnonbnventilatorbnsettingsbnthatbnincludebnPEEP.
xbnProgressive
Rationale:bnThisbnisbnnotbnabnseveritybnratiobnoption.
xbnSevere
Rationale:bnThisbnisbnabnseveritybnratiobnofbnlessbnthanbn100bnonbnventilatorbnsettingsbnthatbnincludebnP
EEP.
TestbnTaking
Duringbnthebnearlybnstagesbnofbnacutebnrespiratorybndistressbnsyndromebn(ARDS),bnthebnnursebnshouldb
nmonitorbnforbnwhichbnarterialbnbloodbngasbnchange?bn-bnanswers--respiratorybnalkalosis
arterialbnbloodbngasesbninitiallybnrevealbnabnrespiratorybnalkalosisbnduebntobnthebntachypnea
Thebnnursebnisbnreviewingbnthebnchestbnx-
raybnreportbnofbnabnventilatedbnpatientbnrequiringbnanbnFiO2bnofbn70%.bnWhichbnfindingbnisbnmostbncon
cerning?bn-bnanswers--bilateralbninfiltrates
duringbnthebnearlybnphasesbnofbnacutebnrespiratorybndistressbnsyndromebn(ARDS),bnserialbnchestbnx-
raybncanbnbebnusedbntobnidentifybnthebnbilateralbninfiltratesbnthatbnarebnthebnhallmarkbnsignbnofbnthisbn
diseasebnprocess
Thebnnursebnisbncaringbnforbnabnpatientbnwithbnacutebnrespiratorybndistressbnsyndromebn(ARDS)bnwhose
bnconditionbnisbndeteriorating.bnWhatbnventilatorybnoptionsbnmaybnbebnconsideredbntobnimprovebnrefra
ctorybnhypoxemia?bnSelectbnallbnthatbnapply.bn-bnanswers--
*bnreducebnthebntidalbnvolumebn(thebnmostbncommonbnisbnconventionalbnventilationbnusingbnreducedbn
tidalbnvolumesbnandbnpositivebnend-
expiratorybnpressurebn(PEEP).bnThisbnallowsbnthebnalveolibntobnopenbnandbnremainbnopenbnwhilebnatbnt
hebnsamebntimebnkeepingbnpeakbnairwaybnpressurebnlow.
xbnincreasebnthebnPEEP
Thebnchargebnnursebnisbnrevisingbnthebnventilatedbnpatientsbninbnthebnintensivebncarebnunitbnforbntheirb
nriskbnofbndevelopingbnacutebnrespiratorybndistressbnsyndromebn(ARDS).bnWhichbnpatientsbnshouldbnbeb
nmostbncloselybnmonitoredbnforbnsymptoms?bnSelectbnallbnthatbnapply.bn-bnanswers--
*bn88bnyearbnoldbnwithbnaspirationbnpneumoniabnafterbnabnstrokebn(aspirationbnisbnabnhighbnriskbnforbnA
RDSbndevelopment)
*bn19bnyearbnoldbninvolvedbninbnabnmulti-
carbnaccidentbn(severebntraumabnsuchbnasbnabncarbnaccidentbnisbnabnriskbnfactorbnforbnARDS)
*bn45bnyearbnoldbnwhobnhadbnabnfive-
vesselbncoronarybnbypassbngraftbnsurgerybn(thosebnwhobnhavebnbeenbnonbncardiopulmonarybnbypassbna
rebnatbnrisk)
xbn54bnyearbnoldbnwithbnabncolostomybnfrombndiverticulitisbn(abdominalbnsurgeriesbnarebnnotbnhigherbnr
isk,bnunlessbninbnthebnpresencebnofbnsepsis)
*bn62bnyearbnoldbnwithbnabnleftbnlobebnremovalbnfrombnlungbncancerbn(abnpneumonectomybnisbnabnriskb
nfactor)
Thebnnursebnisbncaringbnforbnabnpatientbnwithbnanbnincreasedbnriskbnforbndevelopingbnacutebnrespirator
ybndistressbnsyndromebn(ARDS).bnCalculatebnthebnARDSbnratiobnifbnthebnpatient'sbnPaO2bnisbn70bnonbnan
bnFiO2bnofbn60%.bnRoundbntobnthebnnearestbnwholebnnumber.bnEnterbnnumeralbnonly.
Answer
CorrectbnAnswer:bn117
Rationale:bnTobncalculatebnthebnARDSbnratio,bndividebnthebnPaO2bnbybnthebnpercentbnofbnFiO2.bn70/0.60
bn=bn116.6bn=bn117bn-bnanswers--tobncalculatebnthebnARDSbnratio,bn70/0.60bn=bn117
Thebnnursebnisbncaringbnforbnabnpatientbnwithbnacutebnrespiratorybndistressbnsyndromebnwithbnabnseveri
tybnratiobnofbn101bnonbnpositivebnend-
expiratorybnpressurebn(PEEP).bnWhatbncategorybnofbnseveritybnisbnthisbnpatient?bn-bnanswers--
moderate.
xbnMild
, Rationale:bnThisbnisbnabnseveritybnratiobnofbn200-
300bnonbnventilatorbnsettingsbnthatbnincludebnpositivebnend-
expiratorybnpressurebn(PEEP)bnorbncontinuousbnpositivebnairwaybnpressurebn(CPAP).
*bnModerate
Rationale:bnThisbnisbnabnseveritybnratiobnofbn100-200bnonbnventilatorbnsettingsbnthatbnincludebnPEEP.
xbnProgressive
Rationale:bnThisbnisbnnotbnabnseveritybnratiobnoption.
xbnSevere
Rationale:bnThisbnisbnabnseveritybnratiobnofbnlessbnthanbn100bnonbnventilatorbnsettingsbnthatbnincludebnP
EEP.
TestbnTaking
Duringbnthebnearlybnstagesbnofbnacutebnrespiratorybndistressbnsyndromebn(ARDS),bnthebnnursebnshouldb
nmonitorbnforbnwhichbnarterialbnbloodbngasbnchange?bn-bnanswers--respiratorybnalkalosis
arterialbnbloodbngasesbninitiallybnrevealbnabnrespiratorybnalkalosisbnduebntobnthebntachypnea
Thebnnursebnisbnreviewingbnthebnchestbnx-
raybnreportbnofbnabnventilatedbnpatientbnrequiringbnanbnFiO2bnofbn70%.bnWhichbnfindingbnisbnmostbncon
cerning?bn-bnanswers--bilateralbninfiltrates
duringbnthebnearlybnphasesbnofbnacutebnrespiratorybndistressbnsyndromebn(ARDS),bnserialbnchestbnx-
raybncanbnbebnusedbntobnidentifybnthebnbilateralbninfiltratesbnthatbnarebnthebnhallmarkbnsignbnofbnthisbn
diseasebnprocess
Thebnnursebnisbncaringbnforbnabnpatientbnwithbnacutebnrespiratorybndistressbnsyndromebn(ARDS)bnwhose
bnconditionbnisbndeteriorating.bnWhatbnventilatorybnoptionsbnmaybnbebnconsideredbntobnimprovebnrefra
ctorybnhypoxemia?bnSelectbnallbnthatbnapply.bn-bnanswers--
*bnreducebnthebntidalbnvolumebn(thebnmostbncommonbnisbnconventionalbnventilationbnusingbnreducedbn
tidalbnvolumesbnandbnpositivebnend-
expiratorybnpressurebn(PEEP).bnThisbnallowsbnthebnalveolibntobnopenbnandbnremainbnopenbnwhilebnatbnt
hebnsamebntimebnkeepingbnpeakbnairwaybnpressurebnlow.
xbnincreasebnthebnPEEP
