ARDS, Acute Respiratory Failure, ABGs
(Answered)
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)?*
A. The patient is experiencing bradypnea.
B. The patient is tired and confused.
C. The patient's PaO2 remains at 45 mmHg.
D. The patient's blood pressure is 180/96.
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.
2. 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?*
A. "This condition develops because the exocrine glands start to work incorrectly
leading to thick, copious mucous to collect in the alveoli sacs."
B. "ARDS is a pulmonary disease that gradually causes chronic obstruction of
airflow from the lungs."
C. "Acute respiratory distress syndrome occurs due to the collapsing of a lung
because air has accumulated in the pleural space."
D. "This condition develops because alveolar capillary membrane permeability
has changed leading to fluid collecting in the alveoli sacs."
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.
3. 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?*
A. bronchoconstriction
B. atelectasis
C. upper airway blockage
D. pulmonary edema
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.
4. 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?*
A. infiltrates only on the upper lobes
B. enlargement of the heart with bilateral lower lobe infiltrates
C. white-out infiltrates bilaterally
D. normal chest x-ray
The answer is C. This is a finding found in ARDS....pronounce white-out infiltrates
bilaterally.
5. 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?*
A. PaO2 40, pH 7.59, PaCO2 30, HCO3 23
B. PaO2 85, pH 7.42, PaCO2 37, HCO3 26
C. PaO2 50, pH 7.20, PaCO2 48, HCO3 29
D. PaO2 55, pH 7.26, PaCO2 58, HCO3 19
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.
6. Which patient below is at MOST risk for developing ARDS and has the worst
prognosis?*
A. A 52-year-old male patient with a pneumothorax.
B. A 48-year-old male being treated for diabetic ketoacidosis.
C. A 69-year-old female with sepsis caused by a gram-negative bacterial infection.
D. A 30-year-old female with cystic fibrosis.
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.
7. 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:*
A. Drowning
B. Aspiration
C. Sepsis
D. Blood transfusion
(Answered)
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)?*
A. The patient is experiencing bradypnea.
B. The patient is tired and confused.
C. The patient's PaO2 remains at 45 mmHg.
D. The patient's blood pressure is 180/96.
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.
2. 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?*
A. "This condition develops because the exocrine glands start to work incorrectly
leading to thick, copious mucous to collect in the alveoli sacs."
B. "ARDS is a pulmonary disease that gradually causes chronic obstruction of
airflow from the lungs."
C. "Acute respiratory distress syndrome occurs due to the collapsing of a lung
because air has accumulated in the pleural space."
D. "This condition develops because alveolar capillary membrane permeability
has changed leading to fluid collecting in the alveoli sacs."
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.
3. 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?*
A. bronchoconstriction
B. atelectasis
C. upper airway blockage
D. pulmonary edema
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.
4. 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?*
A. infiltrates only on the upper lobes
B. enlargement of the heart with bilateral lower lobe infiltrates
C. white-out infiltrates bilaterally
D. normal chest x-ray
The answer is C. This is a finding found in ARDS....pronounce white-out infiltrates
bilaterally.
5. 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?*
A. PaO2 40, pH 7.59, PaCO2 30, HCO3 23
B. PaO2 85, pH 7.42, PaCO2 37, HCO3 26
C. PaO2 50, pH 7.20, PaCO2 48, HCO3 29
D. PaO2 55, pH 7.26, PaCO2 58, HCO3 19
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.
6. Which patient below is at MOST risk for developing ARDS and has the worst
prognosis?*
A. A 52-year-old male patient with a pneumothorax.
B. A 48-year-old male being treated for diabetic ketoacidosis.
C. A 69-year-old female with sepsis caused by a gram-negative bacterial infection.
D. A 30-year-old female with cystic fibrosis.
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.
7. 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:*
A. Drowning
B. Aspiration
C. Sepsis
D. Blood transfusion
