A patient presents to the urgent care clinic with tachycardia, tachypnea, and diffuse crackles upon auscultation. Which of the following findings would be most consistent with acute respiratory distress syndrome (ARDS)?
Diffuse bilateral opacities apparent on chest radiograph or computed tomography
Chest X-rays may show hyperinflation, flattening of the diaphragm, and increased anterior-posterior diameter
Occasionally, chest X-ray demonstrates increased interstitial markings consistent with thickening of bronchial walls
The chest X-ray may reveal a consolidation or parapneumonic effusion
The Correct Answer is A
Choice A reason: ARDS is characterized by acute onset of hypoxemia and bilateral pulmonary infiltrates not fully explained by cardiac failure or fluid overload. The hallmark radiographic finding is diffuse bilateral opacities on chest imaging, which reflect alveolar damage and fluid accumulation. This is the most consistent and diagnostic imaging feature of ARDS.
Choice B reason: Hyperinflation, flattened diaphragm, and increased anterior-posterior diameter are typical findings in obstructive lung diseases such as chronic obstructive pulmonary disease (COPD), not ARDS. These features suggest air trapping rather than alveolar flooding or collapse.
Choice C reason: Increased interstitial markings and thickened bronchial walls are more indicative of chronic bronchitis or other interstitial lung diseases. These findings are not specific to ARDS and do not reflect the acute alveolar injury seen in ARDS.
Choice D reason: Consolidation or parapneumonic effusion may be seen in bacterial pneumonia or other infectious processes, but they are not characteristic of ARDS. ARDS typically presents with diffuse, non-lobar infiltrates rather than focal consolidation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: While education and discussion about the risks of discontinuing medication are important, trying to convince the patient without respecting autonomy may undermine trust. This approach is paternalistic and does not honor the patient’s legal rights.
Choice B reason: Predicting hospitalization may be perceived as coercive and fear-inducing. It is not appropriate unless there is clear evidence of imminent risk. The patient is currently stable and competent, so this approach is not justified.
Choice C reason: Competent adults have the legal right to refuse medical treatment, including psychiatric medications. The PMHNP should assess the patient’s decision-making capacity and, if intact, respect his autonomy. The provider can offer education and support but must honor the patient’s informed choice.
Choice D reason: This response is inappropriate and stigmatizing. It assumes incompetence without assessment and threatens involuntary hospitalization without cause. Such actions violate ethical and legal standards in psychiatric care.
Correct Answer is D
Explanation
Choice A reason: Bizarre delusions are implausible and not understandable within the context of cultural norms, such as believing aliens implanted a device in one's brain. The belief in an internal rash is not bizarre—it is medically conceivable, though unfounded.
Choice B reason: Referential delusions involve the belief that external events, objects, or people have special meaning or are directed at the individual. This does not apply to the patient's belief about having a rash.
Choice C reason: Nihilistic delusions involve beliefs that one is dead, does not exist, or that the world is ending. These are often seen in severe depression or psychotic states but are unrelated to somatic complaints.
Choice D reason: Somatic delusions involve false beliefs about bodily functions or sensations. The patient’s belief that he has a rash “on the inside” despite no physical evidence is a classic example of a somatic delusion.
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