ARDS NCLEX Questions With 100% Verified Answers Graded A+
Which S&S distinguish hypoxemia from cannula or face mask
hypercapnic respiratory failure? SATA c. Be able to correct the PaO2 to a normal level
a. Cyanosis as quickly as possible
b. Tachypnea d. Base the selection on the patients condition
c. Morning headache and amount of FIO2 needed - ANSWERS -
d. Paradoxical breathing D
e. Use of pursed lip breathing -
ANSWERS - A, B, D
A: Cynosis is a late sign of hypoxemia
B: Tachypnea is a sign of hypoxemia The most common early manifestations of ARDS
D: Paradoxical breathing is a late sign of that the nurse may see are
hypoxmeia a. Dyspnea and tachypnea
C & E are S&S of Hypercapnia b. Cyanosis and apprehension
c. Respiratory distress and frothy sputum
d. Bradycardia and increased work of breathing -
ANSWERS - A
A nurse is reviewing the health records of five
clients. Which of the following clients are at risk
for developing ARDS? (SATA)
a. A client who experienced a near drowning Interventions used in managing the patient with
b. A client following coronary artery bypass graft ARDS includes
surgery SATA
c. A client who has a hemoglobin of 15.1 mg/dL a. IV injection of surfactant
d. A client who has dysphagia b. Aggressive IV fluid resuscitation
E. A client who experienced acute drug toxicity - c. Giving adequate analgesia and sedation
ANSWERS - A: CORRECT - near drowning d. Elevating the HOB 30-45 degrees when supine
incident is at risk for developing ARDS due to e. Monitoring hemodynamic parameters and daily
trauma to lungs and cerebral edema. weights - ANSWERS - C, D, E
B: CORRECT - at risk for developing ARDS due - keep pt dry
to trauma to chest - IV injection - could cause bleeding
C: NO - hemoglobin of 15.1 is within expected
range. Client with low hemoglobin as at risk for
ARDS
D: CORRECT - difficulty swallowing and risk for WHich intervention is most likely to prevent or
aspiration limit volutrauma in the pt with ARDS who is
E: CORRECT - damage to central nervous mechanically ventilated?
system a. Increasing PEEP
b. Increasing the inspiratory flow rate
c. Use of low tidal volume ventilation
d. Suctioning the patient via endotracheal tube
An important consideration in selecting an 02 hourly - ANSWERS - C
delivery device for the patient with acute - pt with ARDS are ventilated with a low VT of 4-8
hypoxemic respiratory failure is to ml/Kg
a. Always start with noninvasive positive - low VT ventilation has reduced mortality and
pressure ventilation risk for volutrauma
b. Apply a low flow device, such as a nasal
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, ARDS NCLEX Questions With 100% Verified Answers Graded A+
results in paradoxical chest movement. Force of
inspiration pulls fractured segment inwards, while
The nurse is assessing the respiratory status of a rest of body expands.
client who has suffered a fractured rib. The nurse
should expect to note which finding?
a. Slow, deep respirations
b. Rapid, deep respirations The pt with pulmonary fibrosis has hypoxemia
c. Paradoxical respirations during exercise but not at rest. To plan patient
d. Pain, especially on inspiration - care, the nurse identifies the patient is
ANSWERS - D experiencing which physiologic mechanism of
Typical signs and symptoms include pain and respiratory failure?
tenderness that is exacerbated by inspiration, a. Diffusion limitation
shallow respirations, b. Intrapulmonary shunt
c. Alveolar hypoventilation
d. Ventilation-perfusion mismatch -
ANSWERS - A
A pt is in acute respiratory distress syndrome pt with pulmonary fibrosis has a thickened
(ARDS) from sepsis. Which measure would be alveolar-capillary interface that slows gas
implemented to maintain cardiac output? transport, so hypoxemia is more likely during
a. Administer IV crystalloid fluids. exercise than at rest. Intrapulmonary shunt
b. Place the patient on a strict fluid restriction. occurs when alveoli fill with fluid (e.g., acute
c. Position the patient in Trendelenburg position. respiratory distress syndrome, pneumonia).
d. Perform chest physiotherapy and assist with Alveolar hypoventilation occurs when there is a
staged coughing. - ANSWERS - A generalized decrease in ventilation (e.g.,
Low cardiac output may necessitate crystalloid restrictive lung disease, central nervous system
fluids in addition to lowering positive end- diseases, neuromuscular diseases). Ventilation-
expiratory pressure (PEEP) or giving inotropes. perfusion mismatch occurs when the amount of
The Trendelenburg position is not recommended air does not match the amount of blood that the
to treat hypotension. Chest physiotherapy is lung receives (e.g., chronic obstructive
unlikely to relieve decreased cardiac output. pulmonary disease, pulmonary embolus).
Fluid restriction would be an inappropriate
intervention.
The nurse is assessing a client with multiple
trauma who is at risk for developing acute
A client with a chest injury has suffered flail respiratory distress syndrome. The nurse should
chest. The nurse assesses the client for which assess for which earliest sign if ARDS?
most distinctive sign of flail chest? a. Bilateral wheezes
a. Cyanosis b. Inspiratory crackles
b. Hypotension c. Intercostal retraction
c. Paradoxical chest movement ebt d. Increased respiratory rate - ANSWERS -
d. Dyspnea, especially on expiration - D
ANSWERS - C Increased respiratory rate is earliest sign of
Flail chest results from multiple rib fractures. This ARDS. Can begin from 1-96 hours after initial
results in a 'floating' section of ribs. This section insult to body. This is followed by increasing
is unattached to rest of bony rib cage, and dyspnea, air hunger, retraction of accessory
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Which S&S distinguish hypoxemia from cannula or face mask
hypercapnic respiratory failure? SATA c. Be able to correct the PaO2 to a normal level
a. Cyanosis as quickly as possible
b. Tachypnea d. Base the selection on the patients condition
c. Morning headache and amount of FIO2 needed - ANSWERS -
d. Paradoxical breathing D
e. Use of pursed lip breathing -
ANSWERS - A, B, D
A: Cynosis is a late sign of hypoxemia
B: Tachypnea is a sign of hypoxemia The most common early manifestations of ARDS
D: Paradoxical breathing is a late sign of that the nurse may see are
hypoxmeia a. Dyspnea and tachypnea
C & E are S&S of Hypercapnia b. Cyanosis and apprehension
c. Respiratory distress and frothy sputum
d. Bradycardia and increased work of breathing -
ANSWERS - A
A nurse is reviewing the health records of five
clients. Which of the following clients are at risk
for developing ARDS? (SATA)
a. A client who experienced a near drowning Interventions used in managing the patient with
b. A client following coronary artery bypass graft ARDS includes
surgery SATA
c. A client who has a hemoglobin of 15.1 mg/dL a. IV injection of surfactant
d. A client who has dysphagia b. Aggressive IV fluid resuscitation
E. A client who experienced acute drug toxicity - c. Giving adequate analgesia and sedation
ANSWERS - A: CORRECT - near drowning d. Elevating the HOB 30-45 degrees when supine
incident is at risk for developing ARDS due to e. Monitoring hemodynamic parameters and daily
trauma to lungs and cerebral edema. weights - ANSWERS - C, D, E
B: CORRECT - at risk for developing ARDS due - keep pt dry
to trauma to chest - IV injection - could cause bleeding
C: NO - hemoglobin of 15.1 is within expected
range. Client with low hemoglobin as at risk for
ARDS
D: CORRECT - difficulty swallowing and risk for WHich intervention is most likely to prevent or
aspiration limit volutrauma in the pt with ARDS who is
E: CORRECT - damage to central nervous mechanically ventilated?
system a. Increasing PEEP
b. Increasing the inspiratory flow rate
c. Use of low tidal volume ventilation
d. Suctioning the patient via endotracheal tube
An important consideration in selecting an 02 hourly - ANSWERS - C
delivery device for the patient with acute - pt with ARDS are ventilated with a low VT of 4-8
hypoxemic respiratory failure is to ml/Kg
a. Always start with noninvasive positive - low VT ventilation has reduced mortality and
pressure ventilation risk for volutrauma
b. Apply a low flow device, such as a nasal
1/7
, ARDS NCLEX Questions With 100% Verified Answers Graded A+
results in paradoxical chest movement. Force of
inspiration pulls fractured segment inwards, while
The nurse is assessing the respiratory status of a rest of body expands.
client who has suffered a fractured rib. The nurse
should expect to note which finding?
a. Slow, deep respirations
b. Rapid, deep respirations The pt with pulmonary fibrosis has hypoxemia
c. Paradoxical respirations during exercise but not at rest. To plan patient
d. Pain, especially on inspiration - care, the nurse identifies the patient is
ANSWERS - D experiencing which physiologic mechanism of
Typical signs and symptoms include pain and respiratory failure?
tenderness that is exacerbated by inspiration, a. Diffusion limitation
shallow respirations, b. Intrapulmonary shunt
c. Alveolar hypoventilation
d. Ventilation-perfusion mismatch -
ANSWERS - A
A pt is in acute respiratory distress syndrome pt with pulmonary fibrosis has a thickened
(ARDS) from sepsis. Which measure would be alveolar-capillary interface that slows gas
implemented to maintain cardiac output? transport, so hypoxemia is more likely during
a. Administer IV crystalloid fluids. exercise than at rest. Intrapulmonary shunt
b. Place the patient on a strict fluid restriction. occurs when alveoli fill with fluid (e.g., acute
c. Position the patient in Trendelenburg position. respiratory distress syndrome, pneumonia).
d. Perform chest physiotherapy and assist with Alveolar hypoventilation occurs when there is a
staged coughing. - ANSWERS - A generalized decrease in ventilation (e.g.,
Low cardiac output may necessitate crystalloid restrictive lung disease, central nervous system
fluids in addition to lowering positive end- diseases, neuromuscular diseases). Ventilation-
expiratory pressure (PEEP) or giving inotropes. perfusion mismatch occurs when the amount of
The Trendelenburg position is not recommended air does not match the amount of blood that the
to treat hypotension. Chest physiotherapy is lung receives (e.g., chronic obstructive
unlikely to relieve decreased cardiac output. pulmonary disease, pulmonary embolus).
Fluid restriction would be an inappropriate
intervention.
The nurse is assessing a client with multiple
trauma who is at risk for developing acute
A client with a chest injury has suffered flail respiratory distress syndrome. The nurse should
chest. The nurse assesses the client for which assess for which earliest sign if ARDS?
most distinctive sign of flail chest? a. Bilateral wheezes
a. Cyanosis b. Inspiratory crackles
b. Hypotension c. Intercostal retraction
c. Paradoxical chest movement ebt d. Increased respiratory rate - ANSWERS -
d. Dyspnea, especially on expiration - D
ANSWERS - C Increased respiratory rate is earliest sign of
Flail chest results from multiple rib fractures. This ARDS. Can begin from 1-96 hours after initial
results in a 'floating' section of ribs. This section insult to body. This is followed by increasing
is unattached to rest of bony rib cage, and dyspnea, air hunger, retraction of accessory
2/7
