MSN Exam for Acute Respiratory Distress Syndrome

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1) CHECK ALL THAT APPLY: Which of the following are early s/sx of ARDS?

  1. Retractions – not always (tissues between ribs and above sternum pull in)
  2. Dyspneic
  3. Non-productive cough
  4. Accessory muscle used
  5. Pallor or cyanosis
  6. Significant CXR changes; pulmonary infiltrates
  7. Restlessness
  8. CXR clear
  9. Respiratory alkalosis
  10. Respiratory acidosis

2) CHECK ALL THAT APPLY: Which of the following are the 5 characteristics of ARDS?

  1. Dyspnea
  2. Myasthenia Gravis
  3. Refractory hypoxemia
  4. Cyanosis
  5. Dense pulmonary infiltrates on CXR
  6. Decreased pulmonary compliance
  7. Non-cardiac pulmonary edema
  8. Chest pain

3) A firefighter who was involved in extinguishing a house fire is being treated for smoke inhalation. He develops severe hypoxia 48 hours after the incident, requiring intubation and mechanical ventilation. Which of the following conditions has he most likely developed?

  1. Acute respiratory distress syndrome (ARDS).
  2. Atelectasis.
  3. Bronchitis.
  4. Pneumonia.

4) During the Fibrotic Phase of ARDS, ____________________ .

  1. fluids shift into the alveoli, the alveoli and bronchii collapse, and lose lung compliance
  2. the lung starts to repair itself; this is where the patient starts to get better or the condition deteriorates.
  3. Fibrous tissue forms and lungs don’t expand well; the effort to breathe increases O2 demand which causes more effort to breathe.

5) A nurse is taking pulmonary artery catheter measurements of a male client with acute respiratory distress syndrome. The pulmonary capillary wedge pressure reading is 12mm Hg. The nurse interprets that this readings is:

  1. High and expected
  2. Low and unexpected
  3. Normal and expected
  4. Uncertain and unexpected

6) A male client has been admitted with chest trauma after a motor vehicle accident and has undergone subsequent intubation. A nurse checks the client when the high-pressure alarm on the ventilator sounds, and notes that the client has absence of breathe sounds in right upper lobe of the lung. The nurse immediately assesses for other signs of:

  1. Right pneumothorax
  2. Pulmonary embolism
  3. Displaced endotracheal tube
  4. Acute respiratory distress syndrome

7) A black male client with asthma seeks emergency care for acute respiratory distress. Because of this client’s dark skin, the nurse should assess for cyanosis by inspecting the:

  1. lips.
  2. mucous membranes.
  3. nail beds.
  4. earlobes.

8) True or False: Management of ARDS are usually only supportive, there is little we can do to reverse the process.

  1. True
  2. False
9) Acute Respiratory Distress Syndrome (ARDS) can be defined as ___________________________.
  1. Sudden life-threatening deterioration of gas exchange in the lungs
  2. Non-cardiac pulmonary edema with increasing hypoxemia despite treatment with O2
  3. Sudden life-threatening pulmonary edema that causes a deterioration of gas exchange despite treatment with O2
10) Which of the following would lead the nurse to suspect that a client with a fracture of the right femur may be developing a fat embolus?
  1. Acute respiratory distress syndrome
  2. Migraine like headaches
  3. Numbness in the right leg
  4. Muscle spasms in the right thigh

11) A nurse is assessing a female client 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?

  1. Bilateral wheezing
  2. Inspiratory crackles
  3. Intercostal retractions
  4. Increased respiratory rate

12) During the Acute Exudate Phase of ARDS, ____________________ .

  1. fluids shift into the alveoli, the alveoli and bronchii collapse, and lose lung compliance
  2. the lung starts to repair itself; this is where the patient starts to get better or the condition deteriorates.
  3. Fibrous tissue forms and lungs don’t expand well; the effort to breathe increases O2 demand which causes more effort to breathe.

13) During the Proliferative Phase of ARDS, ____________________ .

  1. fluids shift into the alveoli, the alveoli and bronchii collapse, and lose lung compliance
  2. the lung starts to repair itself; this is where the patient starts to get better or the condition deteriorates.
  3. Fibrous tissue forms and lungs don’t expand well; the effort to breathe increases O2 demand which causes more effort to breathe.

14) CHECK ALL THAT APPLY: Which of the following are advanced s/sx of ARDS?

  1. Retractions – though not always (tissues between ribs and above sternum pull in)
  2. Dyspneic
  3. Non-productive cough
  4. Accessory muscle used
  5. Pallor or cyanosis
  6. Significant CXR changes; pulmonary infiltrates
  7. Restlessness
  8. CXR clear
  9. Respiratory alkalosis
  10. Respiratory acidosis

15) A male client suffers acute respiratory distress syndrome as a consequence of shock. The client’s condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm?

  1. Kinking of the ventilator tubing
  2. A disconnected ventilator tube
  3. An ET cuff leak
  4. A change in the oxygen concentration without resetting the oxygen level alarm
Answers and Rationales
  1. B. Dyspneic ,C. Non-productive cough ,G. Restlessness , H. CXR clear , I. Respiratory alkalosis
  2. A. Dyspnea , C. Refractory hypoxemia , E. Dense pulmonary infiltrates on CXR , F. Decreased pulmonary compliance , G. Non-cardiac pulmonary edema 
  3. A. Acute respiratory distress syndrome (ARDS). Severe hypoxia after smoke inhalation typically is related to ARDS. The other choices aren’t typically associated with smoke inhalation.
  4. C. Fibrous tissue forms and lungs don’t expand well; the effort to breathe increases O2 demand which causes more effort to breathe. 
  5. C. Normal and expected. The normal pulmonary capillary wedge pressure (PCWP) is 8 to 13 mm Hg, and the client is considered to have high readings if they exceed 18 to 20 mm Hg. The client with acute respiratory distress syndrome has a normal PCWP, which is an expected finding because the edema is in the interstitium of the lung and is noncardiac.
  6. A. Right pneumothorax. Pneumothorax is characterized by restlessness, tachycardia, dyspnea, pain with respiration, asymmetrical chest expansion, and diminished or absent breath sounds on the affected side. Pneumothorax can cause increased airway pressure because of resistance to lung inflation. Acute respiratory distress syndrome and pulmonary embolism are not characterized by absent breath sounds. An endotracheal tube that is inserted too far can cause absent breath sounds, but the lack of breath sounds most likely would be on the left side because of the degree of curvature of the right and left main stem bronchi.
  7. B. mucous membranes. Skin color doesn’t affect the mucous membranes. The lips, nail beds, and earlobes are less reliable indicators of cyanosis because they’re affected by skin color.
  8. A. True 
  9. B. Non-cardiac pulmonary edema with increasing hypoxemia despite treatment with O2
  10. A. Acute respiratory distress syndrome
  11.  D. Increased respiratory rate . The earliest detectable sign of acute respiratory distress syndrome is an increased respiratory rate, which can begin from 1 to 96 hours after the initial insult to the body. This is followed by increasing dyspnea, air hunger, retraction of accessory muscles, and cyanosis. Breath sounds may be clear or consist of fine inspiratory crackles or diffuse coarse crackles.
  12. A. fluids shift into the alveoli, the alveoli and bronchii collapse, and lose lung compliance
  13.  B. the lung starts to repair itself; this is where the patient starts to get better or the condition deteriorates.
  14. A. Retractions – though not always (tissues between ribs and above sternum pull in), D. Accessory muscle used , E. Pallor or cyanosis, F. Significant CXR changes; pulmonary infiltrates , J. Respiratory acidosis 
  15. A. Kinking of the ventilator tubing . Conditions that trigger the high-pressure alarm include kinking of the ventilator tubing, bronchospasm or pulmonary embolus, mucus plugging, water in the tube, coughing or biting on the ET tube, and the client’s being out of breathing rhythm with the ventilator. A disconnected ventilator tube or an ET cuff leak would trigger the low-pressure alarm. Changing the oxygen concentration without resetting the oxygen level alarm would trigger the oxygen alarm.

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