NCLEX Q"s ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)

Question #6 In caring for the patient with ARDS, what is the most characteristic sign the nurse would expect the patient to exhibit? A. Refractory hypoxemia B. Bronchial breath sounds C. Progressive hypercapnia D. Increased pulmonary artery wedge pressure (PAWP)

A. Refractory hypoxemia Rationale:Refractory hypoxemia, hypoxemia that does not respond to increasing concentrations of oxygenation by any route, is a hallmark of ARDS and is always present. Bronchial breath sounds may be associated with the progression of ARDS. PaCO2 levels may be normal until the patient is no longer able to compensate in response to the hypoxemia. Pulmonary artery wedge pressure (PAWP) that is normally elevated in cardiogenic pulmonary edema is normal in the pulmonary edema of ARDS.

Although ARDS may result from direct lung injury or indirect lung injury as a result of systemic inflammatory response syndrome (SIRS), the nurse is aware that ARDS is most likely to occur in the patient with a host insult resulting from A. Sepsis B. Oxygen toxicity C. Prolonged hypotension D. Cardiopulmonary bypass

A. sepsis Rationale: Although ARDS may occur in the patient who has virtually any severe illness and may be both a cause and a result of systemic inflammatory response syndrome (SIRS), the most common precipitating insults of ARDS are sepsis, gastric aspiration, and severe massive trauma.

The nurse suspects the early stage of ARDS in any seriously ill patient who manifests what? A. Develops respiratory acidosis B. Has diffuse crackles and rhonchi C. Exhibits dyspnea and restlessness D. Has a decreased PaO2 and an increased PaCO2

C. Exhibits dyspnea and restlessness. Rationale: Early signs of ARDS are insidious and difficult to detect but the nurse should be alert for any early signs of hypoxemia, such as dyspnea, restlessness, tachypnea, cough, and decreased mentation, in patients at risk for ARDS. Abnormal findings on physical examination or diagnostic studies, such as adventitious lung sounds, signs of respiratory distress, respiratory alkalosis, or decreasing PaO2, are usually indications that ARDS has progressed beyond the initial stages.

A nurse is assessing with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse assesses for which earliest sign of acute respiratory distress syndrome? A. Bilateral wheezing B. Inspiratory crackles C. intercostal retractions D. Increased respiratory rate

D. Increased respiratory rate Rationale: The earliest detectable sign of ARDS is an increased respiratory rate, which can begin from 1-96 hours after the initial injury to the body. This is followed by increasing dyspnea., air hunger, retractions of accessory muscles, and cyanosis. Breath sounds may be clear or consist of fine inspiratory crackles or diffuse coarse crackles.

Prone positioning is considered for a patient with ARDS who has not responded to other measures to increase PaO2. The nurse knows that this strategy will A. increase the mobilization of pulmonary secretions. B. decrease the workload of the diaphragm and intercostal muscles. C. promote opening of atelectatic alveoli in the upper portion of the lung. D. promote perfusion of nonatelectatic alveoli in the anterior portion of the lung.

D. Promote perfusion of nonatelectatic alveoli in the anterior portion of the lung. Rationale: When a patient with ARDS is supine, alveoli in the posterior areas of the lung are dependent and fluid-filled and the heart and mediastinal contents place more pressure on the lungs, predisposing to atelectasis. If the patient is turned prone, air-filled nonatelectatic alveoli in the anterior portion of the lung receive more blood and perfusion may be better matched to ventilation, causing less V/Q mismatch. Lateral rotation therapy is used to stimulate postural drainage and help mobilize pulmonary secretions.

What are the primary pathophysiologic changes that occur in the injury or exudative phase of ARDS (select all that apply)? A. Atelectasis B. Shortness of breath C. Interstitial and alveolar edema D. Hyaline membranes line the alveoli E. Influx of neutrophils, monocytes, and lymphocytes

answer A,C,D Rationale: . The injury or exudative phase is the early phase of ARDS when atelectasis and interstitial and alveoli edema occur and hyaline membranes composed of necrotic cells, protein, and fibrin line the alveoli. Together, these decrease gas exchange capability and lung compliance. Shortness of breath occurs but it is not a physiologic change. The increased inflammation and proliferation of fibroblasts occurs in the reparative or proliferative phase of ARDS, which occurs 1 to 2 weeks after the initial lung injury.