The following questions were created from chapter 67 of Lewis’s Medical Sugrical Nursing 11th Edition Text Book. If you are interested to practice more of these questions, download Lewis’s Med Surge Test Bank PDF.
Management: Respiratory Failure and Acute Respiratory Distress Syndrome Practice Questions and Answers
A patient is admitted to the hospital after being involved in a motor vehicle accident. The patient has asymmetric chest excursion and an absence of breath sounds on the left side. The nurse suspects what?
Left pneumothorax
Right pneumothorax
Pulmonary embolism
Adult respiratory distress syndrome
Answer: Left pneumothorax
When the left part of the chest is crushed, breathing is compromised and asymmetric excursion is seen. This information, along with the absence of breath sounds, is an indication of a left pneumothorax. The injury is located on the left side of the chest. Pulmonary embolism does not present with the given history. There is not enough information to conclude that adult respiratory distress syndrome (ARDS) has developed. Risk for ARDS is greater after the initial injury, not at the time of the injury.
Which pulmonary manifestation is a result of deposition of platelets in the microvasculature?
Answer: Acute respiratory distress syndrome (ARDS)
Thrombotic manifestations occur as a result of fibrin or platelet deposition in the microvasculature. The pulmonary manifestation associated with thrombosis in the microvasculature ARDS.
Which factors put a patient at risk for developing acute disseminated intravascular coagulation (DIC)? Select all that apply
septicemia
an extensive burn
abruptio placentae
severe head trauma
The nurse suspects that a patient with septic shock has developed acute respiratory distress syndrome (ARDS). Which intervention is the nurses priority?
Answer: Begin pulmonary management with mechanical ventilation.
which findings indicate the development of acute respiratory distress syndrome (ARDS) in a patient with systemic response syndrome (SIRS)? Select all that apply.
1 Pulmonary hypertension
2 Decreased lung compliance
3 Decreased minute ventilation
4 Abnormally slow breathing rate
5 Bilateral diffuse infiltrates in the chest
Answer: 1, 2, 5
In patients with SIRS, the inflammatory mediators leading to pulmonary hypertension directly affect the pulmonary vasculature. The patient with acute respiratory distress syndrome shows decreased compliance due to the combined effects of pulmonary vasoconstriction and bronchoconstriction. There are bilateral diffuse fluffy infiltrates seen on the chest x-ray. The minute ventilation increases as the patient experiences tachypnea.
which pathophysiological processes occur during fibrotic phase of acute respiratory distress syndrome (ARDS) Select all that apply.
Answer: 1,2,3
1.Remodeled lung
2.Deceased lung compliance
3.Impairment of gas exchange
4.Development of pulmonary edema
5.Formation of hyaline membranes
Rationale
The fibrotic phase, also known as the chronic or late phase of ARDS, occurs two to three weeks post-lung injury. The lung is completely remodeled by this time with dense and fibrous tissues. The scarring and fibrosis result in the decrease of lung compliance. Impairment in gas exchange is significant because the interstitium is fibrotic in nature. Pulmonary edema occurs in the initial exudative phase of ARDS as the alveolar-pulmonary capillary membrane permeability increases and fluid leaks into the alveoli. Formation of hyaline membranes also occurs in the exudative phase as necrotic cells, proteins, and fibrin line the alveoli, forming membranes that slow gas exchange.
Which interprofessional actions will the nurse imlement when caring for a patient with acute respiratory distress syndrome (ARDS)? Select all that apply.
Answer: 1,3,4
1.use low tidal volumes when ventilating the patient.
2.limit administered oxygen concentration (FIO2) to 70%
3.Allow arterial carbon dioxide level (PaCO2) as high as 60mm Hg.
4.Consider placing the patient in a prone position for several hours daily.
5.maintain positive and expiratory pressure (PEEP) no greater than 5 mm Hg
Which diagnostic testing will the nurse monitor to evaluate for adverse of vancomycin has been prescribed for a patient with acute respiratory distress syndrome (ARDS)?
Answer: creatinine
Which complication will the nurse suspects when a patient who is being mechanically ventilated for acute respiratory distress syndrome (ARDS) suddenly develops tachycardia, has increased respiratory rate, and has absent breath sounds on one side?
Answer: pneumothorax
Which complication can occur when a patient with acute respiratory distress volume (ARDS) Is receiving mechanical ventilation with positive end expiratory pressure (PEEP) or high tidal volumes?
Rationale
Volutrauma can occur with the use of PEEP or when large tidal volumes are delivered to noncompliant lungs
(as occurs in ARDS). Aspiration is a possible complication of intubation and mechanical ventilation but is not caused by high tidal volumes. Stress ulcers may occur in ARDS because blood flow is diverted from the gastrointestinal tract, leading to ischemia, but stress ulcers are not caused by large tidal volumes. Large tidal volumes would be likely to lower carbon dioxide levels rather than cause hypercapnia.
which actions will the nurse plan to implement when caring for a patient with acute respiratory distress syndrome (ARDS) who is receiving mechanical ventilation? slect all that apply.
answers
assist with prone positioning
use chlorhexidine rinse daily for oral care
monitor fluid status with central venous pressures
apply intermittent pneumatic compression stockings
which finding is the best indicator that a patient with viral pneumonia is developing acute respiratory distress syndrome (ARDS)?
Answer: No improvement in O2 saturation with oxygen administration
Rationale:
Refractory hypoxemia is the hallmark characteristic of ARDS. Crackles in the lung bases may occur in the early stages of ARDS, but crackles could also be caused by atelectasis or be a symptom of the patient’s viral pneumonia. A productive cough is more typical of pneumonia than of ARDS. Intercostal retractions occur with increased work of breathing in ARDS but may also be present with viral pneumonia.
Which position is used to decrease atelectasis and improve refractory hypoxemia in patients with acute respiratory distress syndrome (ARDS)?
Answer: prone position
Which finding in a patient who is receiving mechanical positive pressure ventilation with 5cm of positive and expiratory pressure indicates that the patient has severe acute respiratory distress syndrome?
Answer: partial pressure of arterial oxygen /fractional inspired (P/F) ratio is 95.
Which actions will the nurse take to help prevent stress ulcers in a patient with acute respiratory distress syndrome (ARDS) who is receiving mechanical ventilation? select that apply
ANS:
infuse prescribed pantoprazale
Administer prescribed enteral feelings
Which action will the nurse take when caring for a patient with acute respiratory distress syndrome (ARDS) who is receiving continuous lateral rotation therapy (CLRT) while on mechanical ventilation?
Answer: Asses skin condition frequently to detect skin breakdown.
When the nurse is assessing a patient with acute respiratory distress ARDS which finding indicates the need to consider lowering oxygen concentration (FIO2) being delivered by the mechanical ventilator?
Answer: pao2 70mm hg on current oxygen setting quizlet
Which assessment finding in a patient who has been hospitalized for two days with chest trauma after a motor vehicle is most important to communicate to the health care provider?
Answer: Worsening 02 saturation despite receiving 60% oxygen per non-rebreather mask
Which finding by the nurse who is caring for a patient with acute respiratory distress syndrome (ARDS) is most important to report to the health care provider?
Answer: Creatinine 28.mg/dl
Which finding in a patient with possible acute respiratory distress syndrome (ARDS) is most important for the nurse to communicate to the health care provider?
Answer: PaO 2/FIO2 (p/f) ratio decrease from 300 to 100
Which findings will the nurse observe due to compensatory mechanisms in a patient who is the earliest stage of acute respiratory distress syndrome (ARDS)? Select all that apply.
Tachycardia
Respiratory alkalosis
rapid and shallow respirations
Which prescribed intervention for a patient with sepsis, hypotension, and acute respiratory distress syndrome (ARDS) would the nurse question?
Answer: Give furosemide 40mg IV
Which finding in a patient with acute respiratory distress syndrome (ARDS) is the best indicator that placing the patient in the prone position has been effective?
Answer: Oxygen saturation improves
When a patient who has been successfully treated for acute respiratory distress syndrome (ARDS) reports anxiety and vivid dreams that interfere with sleep, which action will the nurse take?
Answer: Refer the patient for counselling
Which actions will the nurse anticipate taking when the cardiac output decreases in a patient who is being treated for acute respiratory distress syndrome (ARDS) with mechanical ventilation and positive end expiratory pressure (PEEP)? Select all that apply.
- infuse inotropic drugs
- Lower the PEEP setting
- Administer crystalloid or colloid fluids
Which clinical manifestations of acute reparatory distress syndrome (ARDS) are caused by increased pulmonary capillary permeability during the initial phase of ARDS? Select all that apply.
- Crackles
- Intercostal retractions
- Decreasing oxygen saturation
Which interprofessional intervention will the nurse anticipate for a patient with intrapulmonary shunt due to acute respiratory distress syndrome (ARDS)?
Positive pressure ventilation
After reviewing a patient’s assessment findings, the nurse suspects a diagnosis of acute respiratory distress syndrome (ARDS). Which phase of ARDS is the patient experiencing?
Answer: Injury phase
Rationale
The injury, or exudative phase, is the first phase in the progression of ARDS. This phase usually occurs 24 to 72 hours after the lung insult or injury and lasts seven days. It is characterized by mild respiratory symptoms (dyspnea, tachypnea, cough, and restlessness). Lung auscultation shows normal lungs or fine scattered crackles. The arterial blood gases (ABGs) show mild hypoxemia and respiratory alkalosis due to hyperventilation. The chest x-ray is usually normal. In the reparative phase (also known as the proliferative phase), signs and symptoms worsen. The chest x-ray begins to show diffuse bilateral infiltrates. In the fibroproliferative phase, scarring of the lungs occurs, and lung compliance is decreased.
The nurse is caring for a patient with acute respiratory distress syndrome (ARDS) who is receiving mechanical ventilation. The nurse monitors for which complications? Select all that apply.
Barotrauma
stress ulcers
acute kidney
venous thromboembolism (VTE)
Ventilator-associated pneumonia
A patient with acute respiratory distress syndrome (ARDS) on mechanical ventilation is receiving vecuronium by continuous IV infusion. The nurse anticipates that which other types of medications will be prescribed?
Answer: An analgesic
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