Chapter 27- Acute Lung Injury and Acute Respiratory Distress Syndrome My Nursing Test Banks

 

1.

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

2.

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

3.

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

4.

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

5.

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.

6.

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

7.

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

8.

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

9.

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

10.

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.

11.

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)

12.

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

13.

A patient with acute respiratory distress syndrome (ARDS) has severe hypoxia refractory to high levels of oxygen and mechanical ventilation. What is the underlying pathophysiology most responsible for the hypoxia?

A)

Increased capillary permeability from mediator release

B)

Increased patchy infiltrate visible on chest x-ray

C)

Reduced pulmonary afterload effects

D)

Reduced pulmonary preload effects

14.

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

15.

A patient with acute respiratory distress syndrome (ARDS) has these arterial blood gas results: pH 7.33, PaCO2 50, HCO3 26, PaO2 80, SaO2 80. The patient is mechanically ventilated with 60% oxygen and positive-end expiratory pressure (PEEP) at 5 cm H2O. These arterial blood gas results, when compared to the previous day, show no improvement in oxygenation and increased PaCO2. When the nurse is assessing these results, what is most significant in evaluating the patients progress?

A)

Patient isnt responding to conventional ventilation therapy.

B)

Development of metabolic alkalosis is compensatory.

C)

Inhaled oxygen and PEEP should be increased.

D)

Change in acidbase balance is ominous.

16.

A patient has acute respiratory distress syndrome (ARDS) and is mechanically ventilated. The patient has not responded to high levels of oxygen and low positive-end expiratory pressure (PEEP), and the ventilator settings are being adjusted. What patient response or ventilator setting limit should the nurse look for to prevent ventilator-associated lung injury (VALI)?

A)

Positive end-expiratory pressure at least 30 cm H2O

B)

Fraction inspired oxygen set at 1.0 (100%)

C)

Measured airway plateau pressure below 30 cm H2O

D)

Respiratory rate between 12 and 20 breaths per minute

17.

The patient has been diagnosed with acute lung injury after submersion in contaminated ground water and probable aspiration. The patient has developed tachycardia, fever, and increased white blood cell count. What does the nurse anticipate will be added to the plan of care?

A)

Prophylactic antibiotics

B)

Nonsteroidal anti-inflammatory drugs (NSAIDs)

C)

Obtaining blood, sputum, urine cultures

D)

Intravenous controlled sedation

18.

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

19.

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.

20.

A patient with acute respiratory distress syndrome (ARDS) is being cared for in a CCU. The nurse implements the ventilator bundle of care. Which of the following statements about this action is true?

A)

Bundles of care strategies combine several strategies that have been shown to improve patient outcomes.

B)

A ventilator bundle is a group of ventilator equipment ordered together from respiratory care.

C)

Protocols for care are called bundles in critical care to differentiate them from routine care.

D)

Each bundle is a defined set of ventilator settings to be used for particular disease processes.

21.

A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation. The patients high airway pressure alarm sounds, and the nurse finds asymmetrical chest expansion and absent breath sounds on the right. What is the probable cause of this situation?

A)

Oversedation

B)

Need for suctioning

C)

Impending respiratory arrest

D)

Acute pneumothorax

22.

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

Answer Key

1.

A

2.

B

3.

A, D

4.

D

5.

D

6.

B

7.

A

8.

A, B, D, F

9.

A, E, F

10.

D

11.

C

12.

A

13.

A

14.

B

15.

D

16.

C

17.

C

18.

D

19.

B

20.

A

21.

D

22.

B, C, E, F

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