ARDS nclex questions

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Lewis Chapter 67: Acute Respiratory ...

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Critical Care exam 1: respiratory Pra...

80 terms jackieD1514Preview Pulmon 18 terms mic 1.) You're providing care to a patient who is being treated for aspiration pneumonia. The patient is on a 100% non- rebreather mask. Which finding below is a HALLMARK sign and symptom that the patient is developing acute respiratory distress syndrome (ARDS)?

• The patient is experiencing bradypnea.
• The patient is tired and confused.
• The patient's PaO2 remains at 45 mmHg.
• The patient's blood pressure is 180/96.

C.The answer is C. A hallmark sign and symptom found in ARDS is refractory hypoxemia. This is where that although the patient is receiving a high amount of oxygen (here a 100% non-rebreather mask) the patient is STILL hypoxic. Option C is the answer because it states the patient's arterial oxygen level is remaining at 45 mmHg (a normal is 80 mmHg but when treating patients with ARDS a goal is at least 60 mmHg). Yes, the patient can be tired and confused from a low oxygen level BUT this question wants to know the HALLMARK sign and symptom.You're teaching a class on critical care concepts to a group of new nurses. You're discussing the topic of acute respiratory distress syndrome (ARDS). At the beginning of the lecture, you assess the new nurses understanding about this condition. Which statement by a new nurse demonstrates he understands the condition?

• "This condition develops because the exocrine glands

start to work incorrectly leading to thick, copious mucous to collect in the alveoli sacs."

• "ARDS is a pulmonary disease that gradually causes

chronic obstruction of airflow from the lungs."

• "Acute respiratory distress syndrome occurs due to the

collapsing of a lung because air has accumulated in the pleural space."

• "This condition develops because alveolar capillary

membrane permeability has changed leading to fluid collecting in the alveoli sacs." D.The answer is D. ARDS is a type of respiratory failure that occurs when the capillary membrane that surrounds the alveoli sac becomes damaged, which causes fluid to leak into the alveoli sac. Option A describes cystic fibrosis, option B describes COPD, and option C describes a pneumothorax.

During the exudative phase of acute respiratory distress syndrome (ARDS), the patient's lung cells that produce surfactant have become damaged. As the nurse you know this will lead to?

• bronchoconstriction
• atelectasis
• upper airway blockage
• pulmonary edema

B.The answer is B. Surfactant decreases surface tension in the lungs. Therefore, the alveoli sacs will stay stable when a person exhales (hence the sac won't collapse).If there is a decrease in surfactant production this creates an unpredictable alveoli sac that can easily collapse, hence a condition called ATELETASIS will occur (collapse of the lung tissue) when there is a decrease production in surfactant.A patient has been hospitalized in the ICU for a near drowning event. The patient's respiratory function has been deteriorating over the last 24 hours. The physician suspects acute respiratory distress syndrome. A STAT chest x-ray is ordered. What finding on the chest x-ray is indicative of ARDS?

• infiltrates only on the upper lobes
• enlargement of the heart with bilateral lower lobe

infiltrates

• white-out infiltrates bilaterally
• normal chest x-ray

C.The answer is C. This is a finding found in ARDS....pronounce white-out infiltrates bilaterally.You're providing care to a patient who was just transferred to your unit for the treatment of ARDS. The patient is in the exudative phase. The patient is ordered arterial blood gases. The results are back. Which results are expected during this early phase of acute respiratory distress syndrome that correlates with this diagnosis?

• PaO2 40, pH 7.59, PaCO2 30, HCO3 23
• PaO2 85, pH 7.42, PaCO2 37, HCO3 26
• PaO2 50, pH 7.20, PaCO2 48, HCO3 29
• PaO2 55, pH 7.26, PaCO2 58, HCO3 19

A.The answer is A. This option demonstrates respiratory alkalosis. In the early stages of ARDS (exudative) the patient will start to enter in respiratory alkalosis. The patient starts to have tachypnea (the body's way of trying to increase the oxygen level but it can't). They will have a very low PaO2 level (normal PaO2 is 80 mmHg), the blood pH will become high (normal is 7.35-7.45) (alkalotic). In the late stage, the patient can enter into respiratory acidosis.Which patient below is at MOST risk for developing ARDS and has the worst prognosis?

• A 52-year-old male patient with a pneumothorax.
• A 48-year-old male being treated for diabetic

ketoacidosis.

• A 69-year-old female with sepsis caused by a gram-

negative bacterial infection.

• A 30-year-old female with cystic fibrosis.

C.The answer is C. Sepsis is the MOST common cause of ARDS because of systemic inflammation experienced. This is also true if the cause of the sepsis is a gram- negative bacterium (this also makes the infection harder to treat...hence poor prognosis). With sepsis, the immune cells that are present with the inflammation travel to the lungs and damage the alveolar capillary membrane leading to fluid to leak in the alveolar sacs.. As the nurse you know that acute respiratory distress syndrome (ARDS) can be caused by direct or indirect lung injury. Select below all the INDIRECT causes of

ARDS:

• Drowning
• Aspiration
• Sepsis
• Blood transfusion
• Pneumonia
• Pancreatitis

C D F

The answers are: C, D, F Indirect causes are processes that can cause

inflammation OUTSIDE of the lungs....so the issue arises somewhere outside the lungs. Therefore, sepsis (infection...as long as it is outside the lungs), blood transfusion, and pancreatitis are INDIRECT causes. Drowning, aspiration, and pneumonia are issues that arise in the lungs (therefore, they are DIRECT causes of lung injury).

A patient is on mechanical ventilation with PEEP (positive end-expiratory pressure). Which finding below indicates the patient is developing a complication related to their therapy and requires immediate treatment?

• HCO3 26 mmHg
• Blood pressure 70/45
• PaO2 80 mmHg
• PaCO2 38 mmHg

B.The answer is B. Mechanical ventilation with PEEP can cause issues with intrathoracic pressure and decrease the cardiac output (watch out for a low blood pressure) along with hyperinflation of the lungs (possible pneumothorax or subq emphysema which is air that escapes into the skin because the lungs are leaking air).You are caring for a patient with acute respiratory distress syndrome. As the nurse you know that prone positioning can be beneficial for some patients with this condition.Which findings below indicate this type of positioning was beneficial for your patient with ARDS?

• Improvement in lung sounds
• Development of a V/Q mismatch
• PaO2 increased from 59 mmHg to 82 mmHg
• PEEP needs to be titrated to 15 mmHg of water

A C The answers are A and C. Prone positioning helps improve PaO2 (82 mmHg is a good finding) without actually giving the patient high concentrations of oxygen. It helps improves perfusion and ventilation (hence correcting the V/Q mismatch). In this position, the heart is no longer laying against the posterior part of the lungs (improves air flow...hence improvement of lung sounds) and it helps move secretions from other areas that were fluid filled and couldn't move in the supine position, hence helping improve atelectasis.A patient is experiencing respiratory failure due to pulmonary edema. The physician suspects ARDS but wants to rule out a cardiac cause. A pulmonary artery wedge pressure is obtained. As the nurse you know that what measurement reading obtained indicates that this type of respiratory failure is NOT cardiac related?

• >25 mmHg
• <10 mmHg
• >50 mmHg
• <18 mmHg

D.The answer is D. A pulmonary artery wedge pressure measures the left atrial pressure. A pulmonary catheter is "wedged" with a balloon in the pulmonary arterial branch to measure the pressure. If the reading is less than 18 mmHg it indicates this is NOT a cardiac issue but most likely ARDS. Therefore, the pulmonary edema is due to damage to the alveolar capillary membrane leaking

fluid into the alveolar sac....NOT a heart problem ex: heart failure.

A nurse must position the patient prone after his diagnosis of acute respiratory distress syndrome (ARDS).Which of the following is a benefit of using this position?Select all that apply.Decreased atelectasis Reduced need for endotracheal intubation Mobilization of secretions Decreased pleural pressure Increased response to corticosteroid therapy decreased atelectasis mobilization of secretions decreased pleural pressure Decreased atelectasis", "Mobilization of secretions" and "Decreased pleural pressure" are correct. Prone positioning, or placing the patient face down with the head turned to the side, helps with pulmonary function in the patient diagnosed with ARDS. When the patient is placed in prone position, the heart and diaphragm are not pressing against the lungs, which means that pleural pressure is reduced.When there is less pressure exerted on the lungs, atelectasis decreases. Studies have shown that many patients in the prone position have increased lung secretions, which improves oxygenation.

A 25-year-old patient in the ICU is being treated for acute respiratory distress syndrome (ARDS). The patient is on a ventilator and requires 80 percent FiO2. Which information would the nurse most likely need to report about the patient to the respiratory therapist working with her?The patient needs an arterial blood gas drawn The patient needs endotracheal suctioning The patient needs more oxygen because of his saturations The patient needs a hemoglobin level drawn arterial blood gases need to be drawn Respiratory therapists have many duties in the healthcare facility and they frequently monitor and work out many technical details of the patients care when a ventilator is being used. A respiratory therapist would most likely change the ventilator settings but the nurse is able to increase the oxygen level on the ventilator and the nurse can suction the patient. It is often part of the job description for a respiratory therapist to draw arterial blood gas levels.A patient who has recovered from ARDS in the ICU is now malnourished and has lost a significant amount of weight. The physician orders TPN to add nutrition for the patient, who then develops re-feeding syndrome. Which of the following signs or symptoms would the nurse expect to see with re-feeding syndrome? Select all that apply.Impaired mental status ( Insulin resistance Seizures Persistent weight loss Constipation impaired mental status insulin resistance seizures "Impaired mental status", "Insulin resistance" and "Seizures" are correct. Re-feeding syndrome can occur as a response to nutrient reintroduction after a period of starvation. When an extremely malnourished patient receives TPN, the body has to adjust to receiving nutrients again, which can cause shifts in electrolytes in the body. These shifts in electrolytes can result in sudden and often fatal complications. Signs and symptoms of re-feeding syndrome include confusion and impaired mental status, insulin resistance, seizures, coma and death.A nurse is caring for a patient with ARDS. Which of the following clinical indicators would signify that this client is in respiratory failure? Select all that apply.Pulse oximetry of 94% on room air A PaO2 level below 60 mmHg An ABG pH level of 7.35 A pCO2 level over 50 mmHg A respiratory rate of over 16/minute PaO2 below 60 PCO2 over 50 respiratory diseases can cause such compromise that the patient will suffer symptoms; however, there are certain clinical indicators that can clarify whether the patient is actually in respiratory failure. Clinical indicators of respiratory failure include pulse oximetry of less than 91% on room air, PaO2 level less than 60 mmHg, and a pCO2 level of over 50 mmHg.A nurse is caring for a patient who is in respiratory distress because of ARDS. Which of the following nursing diagnoses would most likely be associated with this condition?Ineffective tissue perfusion Impaired urinary elimination Disturbed personal identity Ineffective thermoregulation ineffective tissue perfusion Acute respiratory distress syndrome (ARDS) is a life-threatening condition that affects the lungs and prevents the patient from getting enough oxygen. The patient in this situation would most likely have a nursing diagnosis of ineffective tissue perfusion, as decreased oxygen from lung disease prevents adequate oxygen from reaching the bloodstream and the peripheral tissues.