Quiz :Acute Respiratory Distress Syndrome (ARDS)
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Take our ' Acute Respiratory Distress Syndrome (ARDS)' quiz and test your knowledge of the concept. ARDS can occur when fluid builds up in the air sacs keeping your lungs from filling with enough air; therefore, oxygen reaches your bloodstream. Did you know that chest tubes drain the said liquids from around your lungs? A medical practitioner should have good coverage of this to better care for a victim. Take the quiz and test your preparedness. Good Luck & prepare well!
- 1.
A nurse should interpret which of the following as an early sign of a tension pneumothorax in a client with chest trauma?
- A.
Diminished bilateral breath sounds
- B.
Muffled heart sounds
- C.
Respiratory distress
- D.
Tracheal deviation
Correct Answer
C. Respiratory distressExplanation
Respiratory distress is a universal finding of a tension pneumothorax. Unilateral, diminished or absent breath sounds is also a common finding (not bilateral). Tracheal deviation is not always present, and is typically a late sign, when it is seen. Muffled heart sounds are seen in pericardial tamponadeRate this question:
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- 2.
A nurse is to administer 10 mg of morphine sulfate to a client with three fractures ribs. The available concentration for this drug is 15mg/mL. How many milliliters should the nurse administer? Round to one decimal point. Answer: _________ mL's.
Correct Answer
0.7Explanation
10mg/X mL = 15mg/1mL
15mg x XmL = 10mg X 1 mL
15X = 10
X = 0.6667
X = 0.7 mLRate this question:
- 3.
A client with rib fractures and a pneumothorax has a chest tube inserted that is connected to water-seal drainage. The nurse notes that the fluid in the water-seal column is fluctuating with each breath that the client takes. What is the significance of this fluctuation?
- A.
An obstruction is present in the chest tube
- B.
The client is developing subcutaneous emphysema
- C.
The chest tube system is functioning properly
- D.
There is a leak in the chest tube system
Correct Answer
C. The chest tube system is functioning properlyExplanation
Fluctuation of fluid in the water-seal column with respirations indicates that the system is functioning properly. If an obstruction were present in the chest tube, fluid fluctuation would be absent. Subcutaneous emphysema occurs when air pockets can be palpated beneath the client's skin around the chest tube insertion site. A leak in the system is indicated when continuous bubbling occurs in the water-seal column.Rate this question:
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- 4.
A client who is recovering from chest trauma is to be discharged home with a chest tube drainage system intact. The nurse should instruct the client to call the physician for which of the following?
- A.
Respiratory rate greater than 16 breaths/minute
- B.
Continuous bubbling in the water-seal chamber
- C.
Fluid in the chest tube
- D.
Fluctuation of fluid in the water-seal chamber
Correct Answer
B. Continuous bubbling in the water-seal chamberExplanation
Continuous bubbling in the water-seal chamber indicates a leak in the system, and the client needs to be instructed to notify the physician if continuous bubbling occurs. A respiratory rate of more than 16 breaths/minute may not be unusual and does not necessarily warrant a call to the physician. Fluid in the chest tube is expected, as is fluctuation of the fluid in the water-seal chamber.Rate this question:
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- 5.
Which of the following findings would suggest pneumothorax in a trauma victim?
- A.
Pronounced crackles
- B.
Inspiratory wheezing
- C.
Dullness on percussion
- D.
Absent breath sounds
Correct Answer
D. Absent breath soundsExplanation
Pneumothorax means that the lung has basically collapsed and is not functioning. The nurse would hear no movement of air on auscultation. Movement of air through mucous produces crackles. Wheezing occurs when airways become obstructed/narrowed. Dullness on percussion indicates increased density of lung tissue, usually caused by accumulation of fluid.Rate this question:
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- 6.
A 21-year old male is transported by ambulance to the emergency department after a serious automobile accident. He complains of severe pain in his right chest where he struck the steering wheel. Which is the primary client goal at this time?
- A.
Reduce the client's anxiety
- B.
Maintain adequate oxygenation
- C.
Decrease chest pain
- D.
Maintain adequate circulating volume
Correct Answer
B. Maintain adequate oxygenationExplanation
Blunt chest trauma may lead to respiratory failure, and maintenance of adequate oxygenation is the priority for the client. Decreasing the client's anxiety is related to maintaining effective respirations and oxygenation. Although pain is distressing to the client and can increase anxiety and decrease effectiveness, pain control is secondary to maintaining oxygenation. Maintaining adequate circulatory volume is also secondary to maintaining adequate oxygenation.Rate this question:
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- 7.
For a client with rub fractures and a pneumothorax, the physician prescribes morphine sulfate, 1 to 2 mg/hour, given IV as needed for pain. The nursing care goal is to provide adequate pain control so that the client can breathe effectively. Which of the following outcomes would indicate successful achievement of this goal?
- A.
Pain rating of 0 on a scale of 0-10 by the client
- B.
Decreased client anxiety
- C.
Respiratory rate of 26 breaths/minute
- D.
Pa02 of 70 mm Hg
Correct Answer
A. Pain rating of 0 on a scale of 0-10 by the clientExplanation
Look at the question again - "the nursing care goal is to provide ADEQUATE PAIN RELIEF". Only the first answer choice addresses that.Rate this question:
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- 8.
A client undergoes surgery to repair lung injuries. Postop orders include the transfusion of one unit of packed red blood cells at a rate of 60 mL/hour. How long would this transfusion take?
- A.
2 hours
- B.
4 hours
- C.
6 hours
- D.
8 hours
Correct Answer
B. 4 hoursExplanation
A unit of PRBCs is about 250mLs. 250 divided by 6 is around 4 - you cannot infuse a unit of blood for more than 4 hours.Rate this question:
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- 9.
The primary reason for infusing blood at a rate of 60 mL/hour is to help prevent which of the following complications?
- A.
Emboli formation
- B.
Fluid volume overload
- C.
Red blood cell hemolysis
- D.
Allergic reaction
Correct Answer
B. Fluid volume overloadExplanation
Remember the phrase "blood is thicker than water"? It's true - literally. Blood has more density and can cause more fluid volume overload than the same amount of IV fluids. None of the other things are related to rapid infusion.Rate this question:
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- 10.
A client's chest tube is to be removed by the physician. Which of the following items should the nurse have ready to be placed directly over the wound when the chest tube is removed?
- A.
Butterfly dressing
- B.
Montgomery strap
- C.
Fine-mesh gauze dressing
- D.
Petroleum gauze dressing
Correct Answer
D. Petroleum gauze dressingExplanation
The petroleum gauze dressing creates an airtight seal that prevents air leakage in either direction. Mesh gauze would allow air movement. Montgomery straps are most often used with abdominal dressings, and butterfly dressings are used in lieu of stitches in smaller clean open cuts.Rate this question:
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- 11.
A client has been in a car accident and the nurse is assessing for possible pneumothorax. The nurse should assess for:
- A.
Sudden, sharp chest pain
- B.
Wheezing breath sounds over affected side
- C.
Hemoptysis
- D.
Cyanosis
Correct Answer
A. Sudden, sharp chest painExplanation
Signs of pneumothorax: sudden, sharp chest pain; tachypnea; tachycardia; absent or diminished breath sounds over the affected lung; anxiety; restlessness. Cyanosis MAY be seen, but is not ALWAYS seen.Rate this question:
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- 12.
The physician has inserted a chest tube in a client with a pneumothorax. The nurse should evaluate the effectiveness of the chest tube:
- A.
For administration of oxygen
- B.
To promote formation of lung scar tissue
- C.
To insert antibiotics into the pleural space
- D.
To remove air and fluid
Correct Answer
D. To remove air and fluidExplanation
Chest tubes are used to re-expand the lung and remove air and fluid.Rate this question:
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- 13.
The nurse has placed the intubated client with ARDS in prone position for 30 minutes. Which of the following would require the nurse to discontinue prone positioning and return the client to the supine position? Select all that apply.
- A.
The family is coming in to visit
- B.
The client has increased secretions requiring frequent suctioning
- C.
The Sp02 and P02 have decreased
- D.
The client is tachycardic with drop in blood pressure
- E.
The face has increased skin breakdown and edema
Correct Answer(s)
C. The Sp02 and P02 have decreased
D. The client is tachycardic with drop in blood pressure
E. The face has increased skin breakdown and edemaExplanation
Prone position is used to improve oxygenation, ventilation, and perfusion. The importance of this should be explained to the family. Prone position also provides for increased mobilization of secretions, so "increased secretions requiring frequent suctioning" is actually a good thing. If the oxygen sats are going down and the heart rate is up with a drop in BP, he must be returned to normal position immediately. Facial edema is expected - but actual skin breakdown is not.Rate this question:
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- 14.
The nurse has calculated a low P/F ratio < 150 for a client with ARDS. The nurse should place the client in which position to improve oxygenation, ventilation distribution, and drainage of secretions?
- A.
Supine
- B.
Semi-fowlers
- C.
Lateral side
- D.
Prone
Correct Answer
D. ProneExplanation
Prone position in ARDS is used to improve oxygenation, ventilation, and perfusion and help mobilize secretions.Rate this question:
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- 15.
A client with ARDS has fine crackles at the lung bases and the respirations are shallow at a rate of 28 breaths/minute. The client is restless and anxious. In addition to monitoring the arterial blood gas results, the nurse should do which of the following? Select all that apply.
- A.
Monitor serum creatinine and BUN levels
- B.
Administer a sedative
- C.
Keep the head of the bed flat
- D.
Administer humidified oxygen
- E.
Auscultate the lungs
Correct Answer(s)
A. Monitor serum creatinine and BUN levels
D. Administer humidified oxygen
E. Auscultate the lungsExplanation
ARDS is known to cause renal failure and superinfection, so monitoring BUN/Cr is a must. Sedation is given VERY sparingly - the restlessness and anxiety is due to the oxygenation problem - so you need to fix the oxygenation problem, not sedate them. Putting the head of the bed flat would make it harder to breathe. Humidified oxygen would help promote oxygenation and mobilize secretions, and you definitely need to listen to the lungs.Rate this question:
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- 16.
Which of the following interventions would be most likely to prevent the development of ARDS?
- A.
Teaching cigarette smoking cessation
- B.
Maintaining adequate serum potassium levels
- C.
Monitoring clients for signs of hypercapnia
- D.
Replacing fluids adequately during hypovolemic states
Correct Answer
D. Replacing fluids adequately during hypovolemic statesExplanation
One of the MAJOR risk factors for ARDS is hypovolemic shock.Rate this question:
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- 17.
The nurse interprets which of the following as an early sign of ARDS?
- A.
Elevated carbon dioxide level
- B.
Hypoxia not responsive to oxygen therapy
- C.
Metabolic acidosis
- D.
Severe, unexplained electrolyte imbalance
Correct Answer
B. Hypoxia not responsive to oxygen therapyExplanation
A hallmark of early ARDS is refractive hypoxia (hypoxia that doesn't get better with treatment).Rate this question:
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- 18.
A client with ARDS is showing signs of increased dyspnea. The nurse reviews a report of ABGs that recently arrived:pH 7.35PaC02 25 mm HgHC03 22 mEq/LPa02 95 mm HgWhich finding should the nurse report to the physician?
- A.
PH
- B.
PaC02
- C.
HC03
- D.
Pa02
Correct Answer
B. PaC02Explanation
The normal range for PaC02 is 35-45; this is very low.Rate this question:
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- 19.
A client with ARDS is on a ventilator. The client's peak inspiratory pressure and spontaneous respiratory rate are increasing, and the P02 is not improving. Using the SBAR technique, the nurse calls the physician with the recommendation for:
- A.
Initiating IV sedation
- B.
Starting a high protein diet
- C.
Providing pain medication
- D.
Increasing the ventilator rate
Correct Answer
A. Initiating IV sedationExplanation
The client is "fighting" the ventilator and needs sedation to help relax. You always want to be careful with sedation and ARDS patients - it is most dangerous when they are not on a ventilator, but you can still oversedate a patient on a ventilator as well. Use only as much as is needed.Rate this question:
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- 20.
A client has the following ABG values:pH 7.52Pa02 50 mm HgPaC02 28 mm HgHC03 24 mEq/LBased on the client's Pa02, which of these conclusions would be accurate?
- A.
The client is severely hypoxic
- B.
The oxygen level is low but poses no risk for the client
- C.
The client's Pa02 level is within normal range
- D.
The client requires oxygen therapy with very low oxygen concentrations
Correct Answer
A. The client is severely hypoxicExplanation
Normal Pa02 is 80-100 mm Hg; this client is severely hypoxic.Rate this question:
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- 21.
A client has the following ABG values:pH 7.52Pa02 50 mm HgPaC02 28 mm HgHC03 24 mEq/LThe nurse determines that which of the following is a possible cause for these findings?
- A.
COPD
- B.
DKA with Kussmaul's respirations
- C.
Myocardial infarction
- D.
Pulmonary embolus
Correct Answer
D. Pulmonary embolusExplanation
PaC02 of 28 mm Hg and Pa02 of 50 mm Hg are both abnormal, and the low Pa02 signifies acute respiratory failure. A PE would cause respiratory distress and anxiety (breathing fast...blowing off their C02). COPD is typically associated with respiratory acidosis and elevated PaC02. DKA is typically associated with metabolic acidosis. An MI doesn't usually cause an acid-base imbalance.Rate this question:
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- 22.
Which of the following interventions should the nurse anticipate in a client who has been diagnosed with ARDS?
- A.
Tracheostomy
- B.
Use of a nasal cannula
- C.
Mechanical ventilation
- D.
Insertion of a chest tube
Correct Answer
C. Mechanical ventilationExplanation
Patients with ARDS will need intubation and mechanical ventilation.Rate this question:
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- 23.
Which of the following conditions can place a client at risk for ARDS?
- A.
Septic shock
- B.
COPD
- C.
Asthma
- D.
Heart failure
Correct Answer
A. Septic shockExplanation
Septic shock is a common cause of ARDS. Other common causes: hypovolemic shock and GI content aspiration.Rate this question:
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- 24.
Which one of the following assessments is most appropriate for determining the correct placement of an endotracheal tube in a mechanically ventilated client?
- A.
Assessing the client's skin color
- B.
Monitoring the respiratory rate
- C.
Verifying the amount of cuff inflation
- D.
Auscultating breath sounds bilaterally
Correct Answer
D. Auscultating breath sounds bilaterallyExplanation
Checking for breath sounds on both sides is crucial! If you only hear lung sounds on one side, the tube is not inserted correctly. Xray is often done when a patient is intubated.Rate this question:
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- 25.
Which of the following nursing interventions would promote effective airway clearance in a client with ARDS?
- A.
Administering oxygen every 2 hours
- B.
Turning the client every 4 hours
- C.
Administering sedatives to promote rest
- D.
Suctioning if cough is ineffective
Correct Answer
D. Suctioning if cough is ineffectiveExplanation
Look at the question again: would PROMOTE AIRWAY CLEARANCE. Only suctioning will do that. Every 2 hours is not often enough - they will be on continuous oxygen. Turning every 4 hours is not often enough, and you want to be VERY careful with sedatives with ARDS patients - and sedatives won't help promote airway clearance anyway!Rate this question:
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- 26.
Which of the following complications is associated with mechanical ventilation?
- A.
GI hemorrhage
- B.
Immunosuppression
- C.
Increased cardiac output
- D.
Pulmonary emboli
Correct Answer
A. GI hemorrhageExplanation
GI bleed due to stress ulcers occurs in about 25% of clients on mechanical ventilation - this is why everyone on a ventilator is also on some sort of GI protective medication (Protonix, etc.)Rate this question:
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- 27.
A client is admitted to the ER with a headache, weakness, and slight confusion. The physician diagnoses carbon monoxide poisoning. What should the nurse do first?
- A.
Initiate gastric lavage
- B.
Maintain body temperature
- C.
Administer 100% oxygen by mask
- D.
Obtain a psychiatric referral
Correct Answer
C. Administer 100% oxygen by maskExplanation
You need to "knock off" the carbon monoxide with oxygen in an attempt to replace it at its receptor sites.Rate this question:
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- 28.
A confused client with carbon monoxide poisoning experiences dizziness when ambulating to the bathroom. The nurse should:
- A.
Put all four side rails up
- B.
Ask the unlicensed personnel to place restraints on the client's wrists
- C.
Request that the client's roommate put the call light on when he tries to get out of bed
- D.
Check on the client at regular intervals to ascertain the need for toileting
Correct Answer
D. Check on the client at regular intervals to ascertain the need for toiletingExplanation
Frequent rounding! Restraints are not a first option - so all four side rails and wrist restraints are out. The client's roommate is not your assistant.Rate this question:
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- 29.
Which of the following are expected outcomes for a client with pulmonary disease?
- A.
A relatively matched ventilation-to-perfusion ratio
- B.
A low ventilation to perfusion ratio
- C.
A high ventilation to perfusion ratio
- D.
An equal Pa02 and PaC02 ratio
Correct Answer
A. A relatively matched ventilation-to-perfusion ratioExplanation
Definitely want a matched ventilation-perfusion ratio! Ventilation = the oxygen that goes in. Perfusion=the oxygen that gets to all the places that need it. If the ratio is matched, then all the oxygen that goes in gets to where it is needed.Rate this question:
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Jul 03, 2024Quiz Edited by
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Jan 27, 2016Quiz Created by
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