ARDS nclex questions
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Which S&S distinguish hypoxemia from hypercapnic respiratory
failure? SATA A, B, D
a. Cyanosis A: Cynosis is a late sign of hypoxemia
b. Tachypnea B: Tachypnea is a sign of hypoxemia
c. Morning headache D: Paradoxical breathing is a late sign of hypoxmeia
d. Paradoxical breathing C & E are S&S of Hypercapnia
e. Use of pursed lip breathing
A nurse is reviewing the health records of five clients. Which of the A: CORRECT - near drowning incident is at risk for developing
following clients are at risk for developing ARDS? (SATA) ARDS due to trauma to lungs and cerebral edema.
a. A client who experienced a near drowning B: CORRECT - at risk for developing ARDS due to trauma to chest
b. A client following coronary artery bypass graft surgery C: NO - hemoglobin of 15.1 is within expected range. Client with
c. A client who has a hemoglobin of 15.1 mg/dL low hemoglobin as at risk for ARDS
d. A client who has dysphagia D: CORRECT - difficulty swallowing and risk for aspiration
E. A client who experienced acute drug toxicity E: CORRECT - damage to central nervous system
An important consideration in selecting an 02 delivery device for
the patient with acute hypoxemic respiratory failure is to
a. Always start with noninvasive positive pressure ventilation
b. Apply a low flow device, such as a nasal cannula or face mask
D
c. Be able to correct the PaO2 to a normal level as quickly as
possible
d. Base the selection on the patients condition and amount of FIO2
needed
The most common early manifestations of ARDS that the nurse
may see are
a. Dyspnea and tachypnea
A
b. Cyanosis and apprehension
c. Respiratory distress and frothy sputum
d. Bradycardia and increased work of breathing
Interventions used in managing the patient with ARDS includes
SATA
a. IV injection of surfactant C, D, E
b. Aggressive IV fluid resuscitation - keep pt dry
c. Giving adequate analgesia and sedation - IV injection - could cause bleeding
d. Elevating the HOB 30-45 degrees when supine
e. Monitoring hemodynamic parameters and daily weights
WHich intervention is most likely to prevent or limit volutrauma in
the pt with ARDS who is mechanically ventilated?
C
a. Increasing PEEP
- pt with ARDS are ventilated with a low VT of 4-8 ml/Kg
b. Increasing the inspiratory flow rate
- low VT ventilation has reduced mortality and risk for volutrauma
c. Use of low tidal volume ventilation
d. Suctioning the patient via endotracheal tube hourly
The nurse is assessing the respiratory status of a client who has
suffered a fractured rib. The nurse should expect to note which
finding? D
a. Slow, deep respirations Typical signs and symptoms include pain and tenderness that is
b. Rapid, deep respirations exacerbated by inspiration, shallow respirations,
c. Paradoxical respirations
d. Pain, especially on inspiration
A pt is in acute respiratory distress syndrome (ARDS) from sepsis. A
Which measure would be implemented to maintain cardiac out- Low cardiac output may necessitate crystalloid fluids in addition
put? to lowering positive end-expiratory pressure (PEEP) or giving
a. Administer IV crystalloid fluids. inotropes. The Trendelenburg position is not recommended to treat
b. Place the patient on a strict fluid restriction. hypotension. Chest physiotherapy is unlikely to relieve decreased
c. Position the patient in Trendelenburg position. cardiac output. Fluid restriction would be an inappropriate inter-
d. Perform chest physiotherapy and assist with staged coughing. vention.
A client with a chest injury has suffered flail chest. The nurse C
assesses the client for which most distinctive sign of flail chest? Flail chest results from multiple rib fractures. This results in a
a. Cyanosis 'floating' section of ribs. This section is unattached to rest of bony
b. Hypotension rib cage, and results in paradoxical chest movement. Force of
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c. Paradoxical chest movement ebt inspiration pulls fractured segment inwards, while rest of body
d. Dyspnea, especially on expiration expands.
A
pt with pulmonary fibrosis has a thickened alveolar-capillary inter-
The pt with pulmonary fibrosis has hypoxemia during exercise but face that slows gas transport, so hypoxemia is more likely during
not at rest. To plan patient care, the nurse identifies the patient is exercise than at rest. Intrapulmonary shunt occurs when alveoli fill
experiencing which physiologic mechanism of respiratory failure? with fluid (e.g., acute respiratory distress syndrome, pneumonia).
a. Diffusion limitation Alveolar hypoventilation occurs when there is a generalized de-
b. Intrapulmonary shunt crease in ventilation (e.g., restrictive lung disease, central nervous
c. Alveolar hypoventilation system diseases, neuromuscular diseases). Ventilation-perfusion
d. Ventilation-perfusion mismatch mismatch occurs when the amount of air does not match the
amount of blood that the lung receives (e.g., chronic obstructive
pulmonary disease, pulmonary embolus).
The nurse is assessing a client with multiple trauma who is at
D
risk for developing acute respiratory distress syndrome. The nurse
Increased respiratory rate is earliest sign of ARDS. Can begin
should assess for which earliest sign if ARDS?
from 1-96 hours after initial insult to body. This is followed by
a. Bilateral wheezes
increasing dyspnea, air hunger, retraction of accessory muscles,
b. Inspiratory crackles
and cyanosis. Breath sounds may be clear or consist of fine
c. Intercostal retraction
inspiratory crackles or diffuse course crackles.
d. Increased respiratory rate
Normal PAWP range 6-12 mmHg
1. a measurement of pulmonary capillary pressure
What is PAWP? 2. reflects left ventricular end-diastolic pressure under normal
conditions
normal cardiac index 2.5-4 L/min/m2
cardiac output divided by body surface area
What is cardiac index? - assessment of the cardiac output value based on the patient's
size
A
A pt with acute respiratory distress syndrome (ARDS) is on pos-
Patients on PPV and PEEP often have decreased cardiac out-
itive pressure ventilation (PPV). The patient's cardiac index is 1.4
put (CO) and cardiac index (CI). High levels of PEEP increase
L/min and pulmonary artery wedge pressure is 8 mm Hg. What
intrathoracic pressure and cause decreased venous return which
order by the provider would the nurse to QUESTION?
results in decreased CO. Interventions to improve CO include
A. Increase PEEP from 10 to 15 cm H2O.
lowering the PEEP, giving crystalloid fluids or colloid solutions,
B. Start a dobutamine infusion at 3 mcg/kg/min.
and use of inotropic drugs (e.g., dobutamine, dopamine). Packed
C. Give 1 unit of packed RBCs over the next 2 hours.
red blood cells may also be administered to improve CO and
D. Change the maintenance IV rate from 75 to 125 mL/hr.
oxygenation if the hemoglobin is less than 9 or 10 mg/dL.
A
Older adult patients are more predisposed to delirium and health
When caring for older adult pts with respiratory failure, the nurse care-associated infections. Older adult patients are not required
will add which intervention to individualize care? to remain in a supine position only and should increase activity
a. Assess frequently for manifestations of delirium. as soon as stability is determined. Endotracheal intubation is not
b. Position the patient in the supine position primarily. provided early, and noninvasive positive pressure ventilation may
c. Provide early endotracheal intubation to reduce complications. be considered as an alternative. The nurse should consider that
d. Delay activity and ambulation to provide additional healing time. the aging process leads to decreased lung elastic recoil, weak-
ened lung muscles and reduced gas exchange, which may make
the patient difficult to wean from the ventilator.
The nurse is admitting a pt with asthma in acute respiratory
distress. The nurse auscultates the pt's lungs and notes cessation
of the inspiratory wheezing. The pt has not yet received any C
medication. What should this finding suggest to the nurse? When a pt in respiratory distress has inspiratory wheezing and
a. Spontaneous resolution of the acute asthma attack then it ceases, it is an indication of airway obstruction. This finding
b. An acute development of bilateral pleural effusions requires emergency action to restore airway patency.
c. Airway constriction requiring immediate interventions
d. Overworked intercostal muscles resulting in poor air exchange
Which pt would most benefit from noninvasive positive pressure
ventilation (NIPPV) to promote oxygenation? D
A. A pt whose cardiac output and blood pressure are unstable. NIPPV such as continuous positive airway pressure (CPAP) is
B. A pt with cystic fibrosis who is currently producing copious
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secretions.
most effective in treating patients with respiratory failure resulting
C. A pt with respiratory failure due to a head injury with loss of
from chest wall and neuromuscular disease. It is not recom-
consciousness.
mended in patients who are experiencing hemodynamic instability,
D. A pr who has respiratory failure because of the progression of
decreased level of consciousness, or excessive secretions.
myasthenia gravis.
The nurse is caring for a pt who has developed acute respiratory
A
failure. Which medication is used to decrease patient pulmonary
For pt with acute respiratory failure related to the heart, morphine
congestion and agitation?
is used to decrease pulmonary congestion as well as anxiety,
a. Morphine
agitation, and pain. Albuterol is used to reduce bronchospasm.
b. Albuterol
Azithromycin is used for pulmonary infections. Methylprednisolone
c. Azithromycin
is used to reduce airway inflammation and edema.
d. Methylprednisolone
B
Arterial blood gas results are reported to the nurse for a patient The arterial blood gas results show the patient is in uncompensat-
admitted with pneumonia: pH 7.31, PaCO2 49 mm Hg, HCO3 ed respiratory acidosis with moderate hypoxemia. Oxygen therapy
26 mEq/L, and PaO2 52 mm Hg. What order should the nurse is indicated to correct hypoxemia secondary to V/Q mismatch.
complete first? Supplemental oxygen should be initiated at 1 to 3 L/min by nasal
a. Administer albuterol inhaler PRN. cannula, or 24% to 32% by simple face mask or Venturi mask to
b. Start oxygen at 2 L/min by nasal cannula. improve the PaO2. Albuterol would be given next if needed for
c. Increase fluid intake to 2500 mL per 24 hours. bronchodilation. Hydration is indicated for thick secretions, and
d. Perform chest physical therapy 4 times per day. chest physical therapy is indicated for patients with 30 mL or more
of sputum production per day.
The nurse is caring for a pt who is admitted with a barbiturate
overdose. The pt is comatose with a BP of 90/60 mm Hg, apical
pulse of 110 beats/min, and respiratory rate of 8 breaths/min. C
Based on the initial assessment findings, the nurse recognizes The pt's respiratory rate is decreased because of barbiturate
that the pt is at risk for which type of respiratory failure? overdose, which caused respiratory depression. The patient is
a. Hypoxemic respiratory failure related to shunting of blood at risk for hypercapnic respiratory failure due to an obtunded
b. Hypoxemic respiratory failure because of diffusion limitation airway causing decreased respiratory rate and thus decreased
C. Hypercapnic respiratory failure related to alveolar hypoventila- CO2 elimination. Barbiturate overdose does not lead to shunting
tion of blood, diffusion limitations, or increased airway resistance.
D. Hypercapnic respiratory failure because of increased airway
resistance
The nurse is caring for a pt with multiple musculoskeletal injuries C
who has developed acute respiratory distress syndrome (ARDS). Stress ulcers prevention includes early initiation of enteral nutrition
Which intervention should the nurse initiate to prevent stress to protect the gastrointestinal (GI) tract from mucosal damage.
ulcers? Monitoring for GI bleeding does not prevent stress ulcers. Venti-
a. Observe stools for frank bleeding and occult blood. lator-associated pneumonia related to aspiration is prevented by
b. Maintain head of the bed elevation at 30 to 45 degrees. elevation of the head of bed to 30 to 45 degrees Stress ulcers are
c. Begin enteral feedings as soon as bowel sounds are present. not caused by anxiety. Stress ulcers are related to GI ischemia
d. Administer prescribed lorazepam (Ativan) to reduce anxiety. from hypotension, shock, and acidosis.
D
The nurse will first position the pt to facilitate ventilation. Addi-
tional oxygen support may be necessary. Refractory hypoxemia
A pt with aspiration pneumonia develops severe respiratory dis- indicates the patient is not demonstrating acute lung injury but
tress. The PaO2 is 42 mmHg and FIO2 is 80%. Which intervention has now developed acute respiratory distress syndrome (ARDS).
should the nurse complete first? If the PaO2 is 42 mm Hg on 80% FIO2 (fraction of inspired oxygen;
A. Stat portable chest radiography. room air is 21% FIO2), then the PaO2/FIO2 ratio is 52.5, indicating
B. Give lorazepam (Ativan) 1 mg IV push. ARDS (PaO2/FIO2 ratio < 200). Stat portable chest radiography
C. Place the patient in a prone position on a rotational bed. may show worsening infiltrates or "white lung." A rotational bed
D. Position the patient with arms supported away from the chest. placing the patient in prone position would be a strategy to use
for select patients with ARDS. Lorazepam (Ativan) 1 mg may be
harmful to this patient's oxygenation status. Further assessment
would be needed to determine safety.
B
When caring for a pt with acute respiratory distress syndrome
The overall goal in caring for the pt with ARDS is for the PaO2 to be
(ARDS), which finding indicates therapy is appropriate?
greater than or equal to 60 mm Hg with adequate lung ventilation
A. Arterial pH is 7.32.
to maintain a normal pH of 7.35 to 7.45. PEEP is usually increased
B. PaO2 is greater than or equal to 60 mm Hg.
for ARDS patients, but a dramatic reduction in BP indicates a
C. PEEP increased to 20 cm H2O caused BP to fall to 80/40.
complication of decreased cardiac output. A positive occurrence
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is a marked improvement in PaO2 from perfusion better matching
D. No change in PaO2 when patient is turned from supine to prone
ventilation when the anterior air-filled, nonatelectatic alveoli be-
position.
come dependent in the prone position.
The nurse is providing care for an older adult pt who has a A
low partial pressure of oxygen in arterial blood (PaO2) due to Augmented coughing and huff coughing techniques may aid the
worsening left-sided pneumonia. Which intervention should the patient in the mobilization of secretions. If positioned side-lying,
nurse use to help the patient mobilize his secretions? the patient should be positioned on his right side (good lung
a. Augmented coughing or huff coughing down) for improved perfusion and ventilation. Suctioning may be
b. Positioning the patient side-lying on his left side indicated but should always be performed cautiously because of
c. Frequent and aggressive nasopharyngeal suctioning the risk of hypoxia. NIPPV is inappropriate in the treatment of
d. Application of noninvasive positive pressure ventilation patients with excessive secretions.
The nurse is caring for a pt with multiple fractured ribs from a
C
motor vehicle crash. Which assessment findings would be early
A change in mental status is an early indication of respiratory
indications that the patient is developing respiratory failure?
failure. The brain is sensitive to variations in oxygenation, arte-
A. Tachycardia and pursed lip breathing
rial carbon dioxide levels, and acid-base balance. Restlessness,
b. Kussmaul respirations and hypotension
confusion, agitation, and combative behavior suggest inadequate
c. Frequent position changes and agitation
oxygen delivery to the brain.
d. Cyanosis and increased capillary refill time
A nurse is caring for a client who has a trache and is receiving
mechanical ventilation. When the low-pressure alarm on the ven-
tilator sounds, it indicates which of the following to the nurse? B
a. Excessive airway secretions THe low-pressure alarm indicates that wither the ventilator tubing
b. A leak within the ventilators circuitry has come apart or the tubing detached front the client
c. Decreased lung compliance
d. The client coughing or attempting to talk
A nurse on a medical unit is caring for a client who aspirated
gastric contents prior to admission. The nurse administers 100%
O2 by nonrebreather mask after the client reports severe dyspnea.
B
Which of the following findings is a clinical manifestations of acute
Ards manifestations includes low PaO2 (<60), even after admin-
respiratory distress syndrome (ARDS)?
istration of oxygen. Hypoxemia after treatment with oxygen is
a. Tympanic temperature 38 (100.4)
manifestation of ARDS
b. PaO2 50mmHg
c. Rhonchi
D. Hypopnea
A nurse in an acute care facility is preparing to admit a client who
has myasthenia gravis. Which of the following supplies should the
nurse place at the client's bedside? C
a. Metered dose inhaler risk of aspiration due to progressive weakness of the oropharyn-
b. Continuous passive motion machine geal muscles.
c. Oral nasal suction equipment
d. External defribrillator pads
A nurse in the ED is assessing a client who was in a motor vehicle
crash. Findings include absent breath sounds in left lower lobe
with dyspnea, BP 118/68 mmHg, HR 124/min, RR 38/min, temp
38.6 (101.4), and SaO2 92% on room air. Which of the following
actions should the nurse take FIRST? C
a. Obtain chest X-ray
b. Prepare for chest tube insertion
c. Administer oxygen via a high flow mask
D. Initiate IV access
A nurse is orienting a new nurse on the purpose of administering
vecuronium to a client who has ARDS. Which of the flowing state-
ments by new nurse indicates understanding of the teaching? B
a. "This medication is given to treat infection" vecuronium is a neuromuscular blocking agent giving to facilitate
b. "This medication is given to facilitate ventilation" ventilation and decrease oxygen consumption.
c. "This medication is given to decrease inflammation"
d. "This mediation is given to reduce anxiety"
A nurse is caring for client who is receiving vercuronium during
mechanical ventilation. Which of the following medications should
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the nurse anticipate administering with this medication? (SATA)
a. Fentanyl
A. CORRECT - pain med administer to pt when neuromuscular
b. Furosemide
blocking agen, such as vecuronium is asminstered
c. Misazolam
C. CORRECT - sedative medication administered to clients
d. Famotidine
e. Dexamethasone
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