Quiz :Acute Respiratory Distress Syndrome (ARDS)

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. 

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?

• An obstruction is present in the chest tube

• The client is developing subcutaneous emphysema

• The chest tube system is functioning properly

• There is a leak in the chest tube system

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?

• Respiratory rate greater than 16 breaths/minute

• Continuous bubbling in the water-seal chamber

• Fluid in the chest tube

• Fluctuation of fluid in the water-seal chamber

Which of the following findings would suggest pneumothorax in a trauma victim?

• Pronounced crackles

• Inspiratory wheezing

• Dullness on percussion

• Absent breath sounds

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?

• Reduce the client's anxiety

• Maintain adequate oxygenation

• Decrease chest pain

• Maintain adequate circulating volume

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?

• Pain rating of 0 on a scale of 0-10 by the client

• Decreased client anxiety

• Respiratory rate of 26 breaths/minute

• Pa02 of 70 mm Hg

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?

• 2 hours

• 4 hours

• 6 hours

• 8 hours

The primary reason for infusing blood at a rate of 60 mL/hour is to help prevent which of the following complications?

• Emboli formation

• Fluid volume overload

• Red blood cell hemolysis

• Allergic reaction

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?

• Butterfly dressing

• Montgomery strap

• Fine-mesh gauze dressing

• Petroleum gauze dressing

A client has been in a car accident and the nurse is assessing for possible pneumothorax.  The nurse should assess for:

• Sudden, sharp chest pain

• Wheezing breath sounds over affected side

• Hemoptysis

• Cyanosis

The physician has inserted a chest tube in a client with a pneumothorax.  The nurse should evaluate the effectiveness of the chest tube:

• For administration of oxygen

• To promote formation of lung scar tissue

• To insert antibiotics into the pleural space

• To remove air and fluid

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. 

• The family is coming in to visit

• The client has increased secretions requiring frequent suctioning

• The Sp02 and P02 have decreased

• The client is tachycardic with drop in blood pressure

• The face has increased skin breakdown and edema

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?

• Supine

• Semi-fowlers

• Lateral side

• Prone

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. 

• Monitor serum creatinine and BUN levels

• Administer a sedative

• Keep the head of the bed flat

• Administer humidified oxygen

• Auscultate the lungs

Which of the following interventions would be most likely to prevent the development of ARDS?

• Teaching cigarette smoking cessation

• Maintaining adequate serum potassium levels

• Monitoring clients for signs of hypercapnia

• Replacing fluids adequately during hypovolemic states

The nurse interprets which of the following as an early sign of ARDS?

• Elevated carbon dioxide level

• Hypoxia not responsive to oxygen therapy

• Metabolic acidosis

• Severe, unexplained electrolyte imbalance

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?

• PH

• PaC02

• HC03

• Pa02

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:

• Initiating IV sedation

• Starting a high protein diet

• Providing pain medication

• Increasing the ventilator rate

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?

• The client is severely hypoxic

• The oxygen level is low but poses no risk for the client

• The client's Pa02 level is within normal range

• The client requires oxygen therapy with very low oxygen concentrations

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?

• COPD

• DKA with Kussmaul's respirations

• Myocardial infarction

• Pulmonary embolus

Which of the following interventions should the nurse anticipate in a client who has been diagnosed with ARDS?

• Tracheostomy

• Use of a nasal cannula

• Mechanical ventilation

• Insertion of a chest tube

Which of the following conditions can place a client at risk for ARDS?

• Septic shock

• COPD

• Asthma

• Heart failure

Which one of the following assessments is most appropriate for determining the correct placement of an endotracheal tube in a mechanically ventilated client?

• Assessing the client's skin color

• Monitoring the respiratory rate

• Verifying the amount of cuff inflation

• Auscultating breath sounds bilaterally

Which of the following nursing interventions would promote effective airway clearance in a client with ARDS?

• Administering oxygen every 2 hours

• Turning the client every 4 hours

• Administering sedatives to promote rest

• Suctioning if cough is ineffective

Which of the following complications is associated with mechanical ventilation?

• GI hemorrhage

• Immunosuppression

• Increased cardiac output

• Pulmonary emboli

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?

• Initiate gastric lavage

• Maintain body temperature

• Administer 100% oxygen by mask

• Obtain a psychiatric referral

A confused client with carbon monoxide poisoning experiences dizziness when ambulating to the bathroom.  The nurse should:

• Put all four side rails up

• Ask the unlicensed personnel to place restraints on the client's wrists

• Request that the client's roommate put the call light on when he tries to get out of bed

• Check on the client at regular intervals to ascertain the need for toileting

Which of the following are expected outcomes for a client with pulmonary disease?

• A relatively matched ventilation-to-perfusion ratio

• A low ventilation to perfusion ratio

• A high ventilation to perfusion ratio

• An equal Pa02 and PaC02 ratio