ARDS

An elderly patient in the ICU with acute respiratory distress syndrome (ARDS) has developed sepsis. Which of the following interventions should the nurse implement to address the sepsis and its symptoms? Select all that apply. A) Antibiotic therapy B) Elevating head of the bed 30 to 45 degrees C) Weaning protocol D) Daily sedation withholding E) Steroid administration F) Activated protein C

A) Antibiotic therapy E) Steroid administration F) Activated protein C

A patient in the ICU with acute respiratory distress syndrome is at increased risk for ventilator-associated pneumonia (VAP). Which of the following interventions should the nurse implement for this patient? Select all that apply. A) Elevate the head of the bed 30 to 45 degrees. B) Weaning protocol C) Antibiotic therapy D) Deep vein thrombosis (DVT) prophylaxis E) Steroid administration F) Peptic ulcer prophylaxis

A) Elevate the head of the bed 30 to 45 degrees. B) Weaning protocol D) Deep vein thrombosis (DVT) prophylaxis F) Peptic ulcer prophylaxis

A patient with acute respiratory distress syndrome (ARDS) has shown no improvement after 8 hours of mechanical ventilation set to maximize fraction of inspired oxygen. The patient is developing pulmonary hypertension. Which intervention would be best for reducing the negative effects of the pulmonary hypertension in this patient via selective pulmonary vasodilation? A) Nitric oxide B) Prophylactic antibiotic therapy C) Corticosteroids D) Neuromuscular blocking agents

A) Nitric oxide

A patient with worsening tachypnea and dyspnea has a PaO2/FiO2 ratio of 190, bilateral infiltrates on chest x-ray, pulmonary artery occlusive pressure (PAOP) of 15 mm Hg, and no indication of left atrial hypertension. Which of these findings indicates that the patient has acute respiratory distress syndrome (ARDS), as opposed to just acute lung injury (ALI)? A) PaO2/FiO2 ratio of 190 B) Bilateral infiltrates on chest x-ray C) PAOP of 15 mm Hg D) No indication of left atrial hypertension

A) PaO2/FiO2 ratio of 190

A patient has experienced an acute lung injury. What factors in the patients history will probably increase his risk for developing adult respiratory distress syndrome (ARDS)? A) Smokes two packs a day B) Drinks one glass of wine on holidays C) Has a sedentary lifestyle D) Has no known chronic diseases

A) Smokes two packs a day

A patient in the ICU with acute respiratory distress syndrome (ARDS) complains of worsening dyspnea. Which of the following physiological changes associated with ARDS are most responsible for this patients impaired ventilation? Select all that apply. A) Decreased lung compliance B) Pulmonary hypertension C) Vasoconstriction of the pulmonary vascular bed D) Increased airway resistance E) Cyanosis F) Multisystem organ dysfunction

A. Decreased lung compliance D. Increased airway resistance

A patient with acute respiratory distress syndrome (ARDS) in the ICU demonstrates diminished cardiac output, resulting in reduced oxygen delivery. Which of the following interventions will increase cardiac output in this patient by increasing contractility? A) Administration of norepinephrine B) Administration of dobutamine C) Administration of diuretics D) Hemoglobin transfusion

B) Administration of dobutamine

The nurse is caring for a patient who is being mechanically ventilated. What strategies have been shown to prevent ventilator-acquired pneumonia (VAP)? Select all that apply. A) Routine prone positioning B) Elevate head of bed 30 degrees if not contraindicated C) Oral care with plaque removal every 2 to 4 hours D) Balanced nutrition by gastric tube E) Continuous subglottic suctioning of secretions F) Frequent turning and chest physiotherapy

B) Elevate head of bed 30 degrees if not contraindicated C) Oral care with plaque removal every 2 to 4 hours E) Continuous subglottic suctioning of secretions F) Frequent turning and chest physiotherapy

Infection and sepsis are significant complications of ARDS. Which nursing action has the highest priority in preventing infection and sepsis? A) Maintain plateau airway pressure below 30. B) Infuse enteral nutrition with minimal interruptions. C) Keep patient sedated to facilitate ventilation. D) Place in prone position every 2 to 4 hours.

B) Infuse enteral nutrition with minimal interruptions.

The nurse is caring for a patient who has developed acute respiratory distress syndrome (ARDS) after smoke inhalation. Based on the pathologic changes in ARDS, the nurse expects what outcome during the first several hours? A) Improvement in airway patency with bronchodilator therapy B) Persistent and worsening hypoxia despite mechanical ventilation C) Evidence of hypercarbic respiratory failure with compensation D) General fluid volume deficit from capillary permeability increase

B) Persistent and worsening hypoxia despite mechanical ventilation

A patient in the ICU was admitted about 24 hours ago with symptoms of acute respiratory distress syndrome (ARDS). He now demonstrates shortness of breath and a respiratory rate of 40 breaths per minute. His heart rate is 115 beats per minute. The nurse notes a bluish tinge in his fingertips. His chest x-ray shows patchy alveolar infiltrate. His body temperature is normal. Which stage of ARDS is this patient most likely in? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4

B) Stage 2

Delivery of a set # of breaths with pt. breaths synchronized with ventilator breaths describes? a. FiO2 b. Tidal volume c. SIMV d. PEEP

c. SIMV

A patient is admitted after an acute lung injury from smoke inhalation. If the patient develops acute respiratory distress syndrome (ARDS), what is the first symptom the nurse will find? A) Patchy infiltrate on chest x-ray B) Pulmonary capillary wedge pressure less than 18 C) Increasing tachypnea and air hunger D) Low plasma brain natriuretic peptide (BNP)

C) Increasing tachypnea and air hunger

Lung volume of normal inhalations & exhalation usually about 6-8 ml/kg IBW describes a. FiO2 b. SIMV c. Tidal Volume d. PEEP

c. Tidal Volume

A patient with acute respiratory distress syndrome (ARDS) demonstrates unmistakable signs of pneumothorax. What is the next intervention that the nurse should implement? A) Increase the peak end-expiratory pressure (PEEP). B) Administer an inotropic agent. C) Elevate the head of the bed to 35 degrees. D) Assist with a chest tube insertion.

D) Assist with a chest tube insertion.

A patient with acute respiratory distress syndrome (ARDS) is receiving an inhaled bronchodilator. What nursing assessment indicates the most important expected outcome of the bronchodilator for this patient? A) Decreased audible wheezing B) Slight tachycardia during treatment C) Increase in mucus suctioned D) Reduction of peak airway pressure

D) Reduction of peak airway pressure

A patient with acute respiratory distress syndrome (ARDS) in the ICU is receiving high-frequency oscillation ventilation (HFOV). Which complication related to this intervention should the nurse be looking for? A) Volutrauma B) Pneumothorax C) Cyanosis D) Trapping of air in the alveoli

D) Trapping of air in the alveoli

Why must patients receiving high-frequency oscillation ventilation (HFOV) be sedated and paralyzed? A) HFOV tends to cause muscle spasms. B) HFOV is traumatic for many patients. C) HFOV is painful. D) With HFOV, oscillation will cease with any change in airway pressure.

D) With HFOV, oscillation will cease with any change in airway pressure.

What is a sign of imminent respiratory arrest? a. Altered mental status b. Pulsus Paradoxus c. Tachycardia d. Wheezing

a. Altered mental status

bilateral improvement of the lungs , and PaO2 levels goes from 48mm/HG to-82 mm/HG a. Because I placed the pt in a Pron position b. Because the meds worked c. Because I am an awesome nurse d. Just because

a. Because I placed the pt in a Pron position

Identify diagnostic criteria for ARDS. (Select all that apply.) a. Bilateral infiltrates on chest x-ray study b. Decreased cardiac output c. PaO2/ FiO2 ratio of less than 200 d. Pulmonary artery occlusion pressure (PAOP) of more than 18 mm Hg

a. Bilateral infiltrates on chest x-ray study c. PaO2/ FiO2 ratio of less than 200

Tachycardia/hypotension - decrease urine out put, increased Creatinine are signs of? a. Cardiovascular & renal hypo-perfusion b. Vascular disorder c. CHF d. AKI

a. Cardiovascular & renal hypo-perfusion

The patient with acute respiratory distress syndrome (ARDS) would exhibit which of the following symptoms? a. Decreasing PaO2 levels despite increased FiO2 administration b. Elevated alveolar surfactant levels c. Increased lung compliance with increased FiO2 administration d. Respiratory acidosis associated with hyperventilation

a. Decreasing PaO2 levels despite increased FiO2 administration

Comparison between serum O2 & o2 concentrate being breathed=room air=21% describes a. FiO2 b. Tidal Volume c. SIMV d. PEEP

a. FiO2

Which of the following are physiological effects of positive end-expiratory pressure (PEEP) used in the treatment of ARDS? (Select all that apply.) a. Increase functional residual capacity b. Prevent collapse of unstable alveoli c. Improve arterial oxygenation d. Open collapsed alveoli

a. Increase functional residual capacity b. Prevent collapse of unstable alveoli c. Improve arterial oxygenation d. Open collapsed alveoli

Which classifiction of medication is fastest & most effective in controlling an emergency airway? a. Induction and neuromuscular blocking agents b. Serotonin inhibitors c. Benzodiazepines d. ACE-U

a. Induction and neuromuscular blocking agents

A patient with acute respiratory distress syndrome (ARDS) who is intubated and receiving mechanical ventilation develops a pneumothorax. Which action will the nurse anticipate taking? a. Lower the positive end-expiratory pressure (PEEP). b. Increase the fraction of inspired oxygen (FIO2). c. Suction more frequently. d. Increase the tidal volume.

a. Lower the positive end-expiratory pressure (PEEP).

A patient with ARDS who is receiving mechanical ventilation using synchronized intermittent mandatory ventilation (SIMV) has settings of fraction of inspired oxygen (FIO2) 80%, tidal volume 500, rate 18, and positive end-expiratory pressure (PEEP) 5 cm. Which assessment finding is most important for the nurse to report to the health care provider? a. Oxygen saturation 99% b. Patient respiratory rate 22 breaths/min c. Crackles audible at lung bases d. Apical pulse rate 104 beats/min

a. Oxygen saturation 99%

Maintains > alveolar pressure than atmospheric pressure to keep alveoli open describes? a. PEEP b. Tidal Volume c. SIMV d. FiO2

a. PEEP

What ABG results do you expect with ARDS? a. PaO2- 40, pH-7.59,PaCO2 -30, HCO- 23 b. PaO2 -50, pH-7.20, PaCo2 -48 HCO3- 29 c. PaO2 -85, pH -7.42,PaCo2-37 HCO3-26 d. PaO2-88, pH- 7.38, PaCO2- 44, HCO3- 24

a. PaO2- 40, pH-7.59,PaCO2 -30, HCO- 23

Which assessment finding by the nurse when caring for a patient with ARDS who is being treated with mechanical ventilation and high levels of positive end-expiratory pressure (PEEP) indicates that the PEEP may need to be decreased? a. The patient has subcutaneous emphysema. b. The patient has a sinus bradycardia with a rate of 52. c. The patients 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.

When prone positioning is used in the care of a patient with acute respiratory distress syndrome (ARDS), which information obtained by the nurse indicates that the positioning is effective? a. The patients PaO2 is 90 mm Hg, and the SaO2 is 92%. b. Endotracheal suctioning results in minimal mucous return. c. Sputum and blood cultures show no growth after 24 hours. d. The skin on the patients back is intact and without redness.

a. The patients PaO2 is 90 mm Hg, and the SaO2 is 92%.

Which are indications for Mechanical Ventilation a. airway disorders b. Poor oxygenation c. apnea d. atelectasis

a. airway disorders b. poor oxygenation c. apnea

The etiology of noncardiogenic pulmonary edema in acute respiratory distress syndrome (ARDS) is related to damage to the: a. alveolar-capillary membrane. b. left ventricle. c. mainstem bronchus. d. trachea.

a. alveolar-capillary membrane

During rounds, the physician alerts the team that proning is being considered for a patient with acute respiratory distress syndrome. The nurse understands that proning is: a. an optional treatment if the PaO2/FiO2 ratio is less 100. b. less of a risk for skin breakdown because the patient is face down. c. possible with minimal help from co-workers. d. used to provide continuous lateral rotational turning.

a. an optional treatment if the PaO2/FiO2 ratio is less 100.

PEEP: a. helps open the alveoli sacs that are collapsed b. helps decrease the cardiac output c. assist the pt. with breathing d. breathes completely for the pt.

a. helps open the alveoli sacs that are collapsed

Patient complains of respiratory distress. They're alert & speaking full sentences with a cough a. respiratory distress with adequate breathing b. respiratory distress with inadequate breathing c. respiratory paralysis d. respiratory arrest

a. respiratory distress with adequate breathing

The nurse is assessing a patient. Which assessment would cue the nurse to the potential of acute respiratory distress syndrome (ARDS)? a. Increased oxygen saturation via pulse oximetry b. Increased peak inspiratory pressure on the ventilator c. Normal chest radiograph with enlarged cardiac structures d. PaO2/FiO2 ratio > 300

b. Increased peak inspiratory pressure on the ventilator

You are providing prone positioning for your ARDS pt. what assessment is beneficial? a. development of a VQ mismatch b. PaO2 level goes from 48mm/hg to 82mm/Hg c. PEEP needs to be titrated to 15mm/Hg PaO2 level goes from 82mm/Hg to 48mm/hg

b. PaO2 level goes from 48mm/hg to 82mm/Hg

Which of the following diagnostic criteria is indicative of ARDS? a. Radiologic evidence of bibasilar atelectasis b. PaO2/FiO2 ratio less than or equal to 200 mm Hg c. Pulmonary artery wedge pressure greater than 18 mm Hg d. Increased static and dynamic compliance

b. PaO2/FiO2 ratio less than or equal to 200 mm Hg

Tx. underlying infection, wash hands,DVT prophylaxis and HOB @ 30% help? a. Support complications of Kidney function b. Support complications of vented pts. c. Support complications of cardiac function d. Support complications of Immune disorder

b. Support complications of vented pts.

Lung volume of nl. inhalations & exhalation usually about 6-8 mL/kg IBW describes? a. FiO2 b. Tidal volume c. SIMV d. PEEP

b. Tidal volume

Tachycardia/hypotension, and decreased urine output, increase creatinine are signs of: a. neuropathy b. cardiovascular & renal perfusion c. Tissue damage d. no idea

b. cardiovascular & renal perfusion

All of the following are complications of mechanical ventilation EXCEPT a. pneumothorax b. increased venous return c. auto-PEEP d. pneumonia

b. increased venous return

When performing a respiratory assessment on a patient, RN notices a costal angle of 90. This is a. observed in patients with kyphosis b. Indicative of pectus excavatum c. A normal finding in a healthy adult d. An expected finding in a patient with a barrel chest

c. A normal finding in a health adult

Which of the following therapeutic measures would be the most effective in treating hypoxemia in the presence of intrapulmonary shunting associated with ARDS? a. Sedating the patient to blunt noxious stimuli b. Increasing the FiO2 on the ventilator c. Administering positive-end expiratory pressure (PEEP) d. Restricting fluids to 500 mL per shift

c. Administering positive-end expiratory pressure (PEEP)

The exudative phase of ARD leads to? a. Bronchoconstriction b. URI blockage c. Atelectasis d. Pulmonary edema

c. Atelectasis

What finding on a CXR idicates ARDS? a. BUL infiltrate b. Normal CXR c. Bilateral whiteout d. Myocardial enlargement

c. Bilateral whiteout

What classification of med is fastest & most effective in controlling emergency airway? a. Benzodiazepine b. Serotonin inhibitors c. Instruction of neuromuscular blocking agents d. Diuretics & Calcium Channel Blockers

c. Instruction of neuromuscular blocking agents

Your pt. has aspiration pneumonia-on 100% rebreather- what is the indicator for ARDS? a. Low resp. rate b. AMS c. Low paO2 D. HTN

c. Low paO2

The basic underlying pathophysiology of acute respiratory distress syndrome results from: a. a decrease in the number of white blood cells available. b. damage to the right mainstem bronchus. c. damage to the type II pneumocytes, which produce surfactant. d. decreased capillary permeability

c. damage to the type II pneumocytes, which produce surfactant.

What statement best describes SIMV? a. used for full ventilator support- the vent delivers at set intervals b. lung volume of normal inhalations and and exhalations usually about 6-8 c. have no clue d. # of breaths with pts breaths synchronize with ventilator breaths

d. # of breaths with pts breaths synchronize with ventilator breaths

Which pt. is Most risk for ARDS and worst prognosis? a. 58 y/o male w/ pneumothorax b. 25 y/o female w/ Cystic Fibrosis c. 45 y/o male w/ DKA d. 72 y/o w/ sepsis

d. 72 y/o w/ sepsis

Sepsis, Blood transfusion, Pancreatitis are indirect causes of? a. Pneumonia b. CHF c. AKI d. ARDS

d. ARDS

Etiology of ARDS: a. ARDS is lymph system causing increase mucus b. ARDS is from Gentamycin serum levels to high c. Ards is collapsed lung from pneumothorax d. Alveolar capillary membrane permeability leading to increase fluids

d. Alveolar capillary membrane permeability leading to increase fluids

During exudative phase of ARDS, surfactant producing lung cells are damaged & leads to? a. Bronchoconstriction b. URI blockage c. PE d. Atelectasis

d. Atelectasis

Pt. is intubated what is the 1st assessment of tube placement? a. CXY b. Pulse Ox c. Ausculation of bowel sounds during a bagged breath d. End tital CO2 monitoring

d. End tital CO2 monitoring

Maintains ^alveolar pressure than atmospheric pressure to keep alveoli open describes? a. Tidal volume b. FiO2 c. SIMV d. PEEP

d. PEEP

Which statement by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to the family members of a patient with ARDS is correct? a. PEEP will prevent fibrosis of the lung from occurring. b. PEEP will push more air into the lungs during inhalation. c. PEEP allows the ventilator to deliver 100% oxygen to the lungs. d. PEEP prevents the lung air sacs from collapsing during exhalation.

d. PEEP prevents the lung air sacs from collapsing during exhalation.

pH=7.47,-PaO2=66-PaCO2=33-HCO3=21 dx is ARDS interpret ABG results- a. Respiratory Acidosis b. Metabolic Acidosis c. Metabolic Alkalosis d. Respiratory Alkalosis

d. Respiratory Alkalosis

A patient has been admitted to the critical care unit with the diagnosis of acute respiratory distress syndrome (ARDS). Arterial blood gasses (ABGs) revealed an elevated pH and decreased PaCO2. The patient is becoming fatigued, and the health care provider orders a repeat ABG. The nurse anticipates the following results a. elevated pH and decreased PaCO2 b. elevated pH and elevated PaCO2 c. decreased pH and decreased PaCO2 d. decreased pH and elevated PaCO2

d. decreased pH and elevated PaCO2