Question 1

Clinical manifestations of ARDS include:
1) low or normal pulmonary capillary wedge pressure (PCWP).
2) tachycardia.
3) intercostal retractions.
4) cyanosis.

Accepted Answer

ARDS is characterized by low or normal PCWP, tachycardia, intercostal retractions, and cyanosis due to impaired gas exchange and respiratory distress.

Question 2

Which of the following can lead to ARDS?
1) Liver failure
2) Burns
3) Septicemia
4) Hemorrhagic pancreatitis

Accepted Answer

ARDS (acute respiratory distress syndrome) is a condition mostly caused by lung injury due to various reasons. Inhalation injury caused by burns, septicemia caused by sepsis, and hemorrhagic pancreatitis can all lead to ARDS. Liver failure is unlikely to cause ARDS, so option A is incorrect. Option B contains only burns and septicemia, while hemorrhagic pancreatitis is also a major cause of ARDS, so option C is the correct answer. Option D is incorrect because liver failure is unlikely to lead to ARDS.

Question 3

The physiologic abnormalities found in the lungs of the ARDS patient include:
1) abnormal surfactant.
2) interstitial edema.
3) decreased shunt.
4) narrowing of the alveolar-capillary membrane.

Accepted Answer

ARDS (Acute Respiratory Distress Syndrome) is characterized by abnormal surfactant and interstitial edema, which contribute to impaired gas exchange and lung function. Decreased shunt and narrowing of the alveolar-capillary membrane are not typical features of ARDS.

Question 4

Your patient has acute respiratory distress syndrome (ARDS). All of the following materials will be found in her alveoli, EXCEPT:

Accepted Answer

In ARDS, the alveoli are filled with cellular debris, fibrin, and hyaline membranes. While leukocytes play a role in the inflammatory response that leads to ARDS, they are not typically found in large quantities within the alveoli themselves. Therefore, the correct answer is A) leukocytes.

Question 5

Your adult male patient weighs 68 kg (150 pounds). Because he has developed ARDS, the physician wants to adjust the mechanical ventilator to minimize further lung injury. What tidal volume should be set for the patient?

Accepted Answer

When a patient develops ARDS, ventilation with large tidal volumes can cause further lung injury. Current guidelines recommend using a low tidal volume ventilation strategy, typically set at 6 mL/kg of predicted body weight. For this patient weighing 68 kg, a tidal volume of 400 ml would be appropriate (6 ml/kg x 68 kg = 408 ml, rounded down to 400 ml). Therefore, the correct answer is B) 400 ml.

Question 6

Your patient has a prolonged case of ARDS. What will happen to his alveolar cells?

Accepted Answer

Prolonged ARDS can lead to hyperplasia and swelling of type II alveolar cells, which are responsible for producing surfactant to prevent the collapse of alveoli. The influx of macrophages and development of emphysema are not typically associated with ARDS, and multiplication of type I cells is not a typical response to injury in the alveoli.

Question 7

Commonly heard breath sounds in a patient with ARDS include:
1) vesicular.
2) bronchovesicular.
3) crackles.
4) bronchial.

Accepted Answer

ARDS (Acute Respiratory Distress Syndrome) is characterized by the presence of crackles and bronchial breath sounds, both of which indicate abnormalities in lung function. The vesicular and bronchovesicular breath sounds are normal sounds heard in healthy people and are not common in patients with ARDS. Therefore, the answer is option C (crackles and bronchial).

Question 8

A patient with massive blood transfusion or disseminated intravascular coagulation (DIC) is at risk for developing ARDS because of:

Accepted Answer

Massive blood transfusion or DIC can lead to blockages in pulmonary blood vessels due to microthrombi, which can contribute to the development of Acute Respiratory Distress Syndrome (ARDS).

Question 9

All of the following would be low tidal volume ventilation goals in a patient with ARDS, EXCEPT:

Accepted Answer

A plateau pressure > 30 cmH2O indicates that the tidal volume is too high, and it can lead to ventilator-induced lung injury. Therefore, the goal is to keep the plateau pressure below 30 cmH2O, and this option is not a low tidal volume ventilation goal. The other options (A, C, and D) are all low tidal volume ventilation goals in ARDS patients.

Question 10

Your patient with ARDS has alveolar consolidation and atelectasis. Which of the following can be used to offset these problems?
1) aerosolized bronchodilator medications
2) continuous positive airway pressure (CPAP)
3) chest percussion and postural drainage
4) positive end-expiratory pressure (PEEP)

Accepted Answer

PEEP helps to keep the alveoli open and prevent atelectasis. CPAP can also help to improve oxygenation and reduce the work of breathing.

Question 11

The ventilation strategy used with most patients with ARDS includes:
1) large tidal volume.
2) small tidal volume.
3) high respiratory rate.
4) low respiratory rate.

Accepted Answer

The ventilation strategy used with most patients with ARDS includes small tidal volume and high respiratory rate, which is represented by choice 2 and 3. Large tidal volume can worsen lung injury in ARDS, so it is not used. Low respiratory rate is not specific to ARDS ventilation strategy.

Question 12

The physician has decided to implement permissive hypercapnia with an ARDS patient receiving mechanical ventilation. What should be the pH goal with the patient?

Accepted Answer

With permissive hypercapnia, the focus is on allowing the partial pressure of carbon dioxide (PaCO2) to rise above normal levels while still maintaining adequate oxygenation. The goal pH range still remains within normal physiology, thus the pH goal should be maintained at a range of 7.35-7.45 to minimize the risk of acidosis or alkalosis. A pH goal of <7.2 would be too low and may lead to adverse effects such as impaired tissue perfusion and acidemia. A pH goal of >7.45 would be too high and may lead to adverse effects such as alkalosis and impaired oxygen delivery to the tissues.

Question 13

The anatomic alterations found in the alveoli of a patient with ARDS are closest to those found with what other disease?

Accepted Answer

The anatomic alterations found in the alveoli of a patient with ARDS are closest to those found with Hyaline membrane disease (also known as respiratory distress syndrome of the newborn), which is characterized by the formation of a proteinaceous material in the alveoli leading to difficulty breathing. Bacterial pneumonia may cause consolidation of lung tissue, congestive heart failure may cause fluid accumulation in the lungs, and emphysema is characterized by destruction of alveolar walls. These conditions have different anatomic alterations than those seen in ARDS.

Question 14

A chest radiograph finding indicative of ARDS is:

Accepted Answer

A "ground-glass" appearance on a chest radiograph is a common finding in patients with ARDS. This is due to the buildup of fluid in the alveoli, causing them to appear hazy or opaque. Pleural effusion and lung hyperinflation can also be seen on chest radiographs in certain cases, but they are not specific to ARDS. Tracheal deviation is a finding that is more suggestive of other conditions, such as a pneumothorax or mediastinal mass.

Question 15

Inhalation of all of the following can lead to ARDS, EXCEPT:

Accepted Answer

Very dry air can cause respiratory problems, but it is not a direct cause of ARDS. The inhalation of greater than 60% oxygen for a long period, nitrogen dioxide, and chlorine gas can all lead to ARDS.

Quiz 27: Acute Respiratory Distress Syndrome

Clinical manifestations of ARDS include: 1) low or normal pulmonary capillary wedge pressure (PCWP) . 2) tachycardia. 3) intercostal retractions. 4) cyanosis.

Which of the following can lead to ARDS? 1) Liver failure 2) Burns 3) Septicemia 4) Hemorrhagic pancreatitis

The physiologic abnormalities found in the lungs of the ARDS patient include: 1) abnormal surfactant. 2) interstitial edema. 3) decreased shunt. 4) narrowing of the alveolar-capillary membrane.

Your patient has acute respiratory distress syndrome (ARDS) . All of the following materials will be found in her alveoli, EXCEPT:

Your adult male patient weighs 68 kg (150 pounds) . Because he has developed ARDS, the physician wants to adjust the mechanical ventilator to minimize further lung injury. What tidal volume should be set for the patient?