ARDS Diagnosis and Management

Article form The Nursing Center
1.
The mortality of Acute Respiratory Distress Syndrome (ARDS) is
a. less than 10%.
b. 25%.
c. 30% to 35%.
d. greater than 50%.
2.
The patient that is most at risk for the development of ARDS is one with
a. a multiple trauma.
b. liver disease.
c. asthma.
d. coronary artery disease and hypertension.
3.
Which of the following comorbid conditions increases the risk of ARDS?
a. chronic alcoholism
b. immunosuppression
c. obesity
d. thyroid disease
4.
Which of the following best describes the pathophysiology of the acute phase of ARDS?
a. decreased microvascular permeability and neutrophil invasion
b. decreased pulmonary macrophase synthesis of interleukin-8
c. release of macrophage inhibitory factor (MIF)
d. influx of protein-rich fluid into the alveoli and interstitium
5.
Diffuse alveolar damage (DAD) best describes
a. early pathological features of ARDS.
b. late inflammatory mediator release features of ARDS.
c. alveolar flooding.
d. intra-alveolar edema and hemorrhage.
6.
When do presenting symptoms of ARDS typically occur after the onset of the predisposing condition?
a. 1 to 2 days
b. 3 to 5 days
c. 1 to 2 weeks
d. 4 weeks or more
7.
Which of the following symptoms of ARDS usually occurs first?
a. agitation
b. bradycardia
c. orthopnea
d. dyspnea
8.
The initial arterial blood gas analysis of the patient with ARDS usually shows acute:
a. respiratory acidosis.
b. respiratory alkalosis.
c. metabolic acidosis.
d. metabolic alkalosis.
9.
The diagnosis of ARDS is
a. based on the patient's arterial blood gas analysis results and pulmonary capillary wedge pressure.
b. based on the presence of right atrial hypertension.
c. a diagnosis of exclusion.
d. based on a specific marker for pulmonary endothelial/epithelial injury.
10.
What is the most common measure used to estimate intrapulmonary physiologic shunting in ARDS?
a. the P/F ratio
b. pulmonary capillary wedge pressure
c. cardiac index
d. the FiO2
11.
What does the initial therapy for ARDS focus on?
a. preventing multiple organ dysfunction syndrome
b. decreasing the P/F ratio
c. increasing preload
d. maintaining adequate oxygenation and tissue perfusion
12.
As defined in this article, "lung protection," is accomplished by the best level of PEEP, permissive hypercapnia, plateau pressures that should not exceed 30 cm H2O, and
a. increased FiO2.
b. low tidal volumes.
c. volume-controlled ventilation.
d. decreased V/Q ratio.
13.
What is the truest measure of lung tissue compliance?
a. cardiac output
b. V/Q ratio
c. static compliance
d. tidal volume
14.
Which of the following best describes the use of PEEP in patients with ARDS?
a. It should not be used.
b. The therapeutic range is 5 to 9 cm H2O.
c. It assists with achieving adequate hemoglobin saturation.
d. It increases the requirements for high fractions of inspired oxygen.
15.
The use of fluids in ARDS management establishes an
a. adequate preload.
b. adequate afterload.
c. increase in hydrostatic pressures across the pulmonary microcirculation.
d. increase in pulmonary capillary wedge pressure.
16.
The mechanism of tissue plasminogen activator (t-PA) in the treatment of ARDS
a. provides anti-inflammatory protection.
b. provides antioxidant protection.
c. inhibits thromboxane A2, a pulmonary vasoconstrictor.
d. alters the coagulation cascade.
17.
Most early causes of death from ARDS are
a. from sepsis.
b. those associated with the presenting illness or injury.
c. associated with multiple organ dysfunction syndrome.
d. from respiratory acidosis.
18.
Which of the following is an early predictor of mortality from ARDS?
a. the degree of lung injury during the initial 1 to 2 days
b. the use of corticosteroids in the first 5 days of therapy
c. unresolved lactic acidosis on day 1
d. uncontrolled hypotension and tachycardia in the first 48 hours
19.
When can near-normal pulmonary function be expected in about one half of ARDS survivors?
a. within 1 month after extubation
b. 6 months after extubation
c. 1 years after extubation
d. 18 months to 2 years after extubation