The nurse caring for a critically ill client would suspect the development of acute respiratory distress syndrome (ARDS) in which of the following situations? The client with:

severe left sided heart failure and resultant pulmonary edema.

acute renal failure associated with pyelonephritis.

a traumatic brain injury with accompanying spinal cord injury.

hypoxemia, refractory to oxygen therapy.

Answer and Explanation

The Correct Answer is D

A) Severe left-sided heart failure and resultant pulmonary edema:
While pulmonary edema due to left-sided heart failure can lead to respiratory distress and hypoxemia, it is not characteristic of ARDS. ARDS is a form of non-cardiogenic pulmonary edema, meaning it is not caused by heart failure. In contrast, pulmonary edema from heart failure is typically related to increased pressure in the pulmonary circulation. Therefore, while this client is at risk for respiratory issues, the cause of their pulmonary edema is distinct from the pathology seen in ARDS.

B) Acute renal failure associated with pyelonephritis:
Acute renal failure from pyelonephritis can lead to various complications, including electrolyte imbalances and fluid overload, which may affect respiratory function. However, renal failure by itself is not a direct cause of ARDS. ARDS is typically associated with an inflammatory response to injury or infection in the lungs, not specifically renal issues. While it’s important to monitor for pulmonary complications in critically ill clients, this situation does not directly suggest ARDS.

C) A traumatic brain injury with accompanying spinal cord injury:
Traumatic brain injury (TBI) with spinal cord injury can lead to respiratory compromise, particularly due to neurological impairment affecting the respiratory muscles or the brain's ability to control breathing. However, ARDS is not the most direct consequence of these injuries. ARDS is primarily caused by acute lung injury from direct or indirect insults to the lungs, such as trauma, pneumonia, or sepsis. Although this combination of injuries may cause respiratory distress, it is not a typical cause of ARDS unless there is another underlying lung injury.

D) Hypoxemia, refractory to oxygen therapy:
This is the hallmark sign of ARDS. ARDS is characterized by the development of acute hypoxemia that is resistant to high levels of supplemental oxygen therapy. This refractory hypoxemia is due to widespread inflammation and damage to the alveolar-capillary membrane, leading to impaired gas exchange. In ARDS, the lungs become less compliant, and the ability to oxygenate blood is significantly reduced, even with mechanical ventilation and high levels of oxygen. Therefore, a critically ill client with hypoxemia that does not improve with oxygen therapy would raise suspicion for the development of ARDS.

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Correct Answer is B

Explanation

A. Guidewire-induced dysrhythmia: Guidewire-induced dysrhythmia can occur if the guidewire or catheter irritates the heart during insertion, particularly when the catheter is placed in the central venous system. While this can lead to arrhythmias, it is typically more immediate and occurs during the procedure itself. The symptoms of dysrhythmia (e.g., irregular heartbeat) would more likely present right after insertion or during the manipulation of the guidewire. The signs of restlessness, JVD, and tachycardia observed 30 minutes after placement are more suggestive of a pneumothorax than of a guidewire-induced dysrhythmia.

B. Pneumothorax: Pneumothorax is a potential complication of central venous catheter (CVC) placement, particularly when the catheter is inserted into the subclavian vein. The right subclavian vein is located near the apex of the lung, so inadvertent puncture of the lung during catheter placement can lead to air entering the pleural space, causing a pneumothorax. The symptoms of pneumothorax may include restlessness, tachycardia, jugular vein distention (JVD), and respiratory distress. A heart rate of 120 beats per minute is consistent with tachycardia due to hypoxia or distress, and JVD can be a sign of increased intrathoracic pressure or impaired venous return, which occurs with a pneumothorax. These symptoms warrant immediate assessment for pneumothorax, which can be confirmed with a chest x-ray.

C. Pulmonary infarction: Pulmonary infarction occurs when a blockage in the pulmonary arteries prevents blood flow to lung tissue, resulting in tissue death. This can be caused by a pulmonary embolism or other issues, but it is not a typical complication of central venous catheter placement. The symptoms described (restlessness, JVD, and tachycardia) are more consistent with a pneumothorax than a pulmonary infarction, which would likely cause chest pain, hemoptysis, or dyspnea rather than these signs.

D. Venous thrombosis: While venous thrombosis (or clot formation) is a potential complication of central venous catheter placement, it typically manifests as swelling, redness, or pain at the catheter insertion site, rather than with the systemic symptoms of restlessness, tachycardia, and JVD. Venous thrombosis could cause some of the described symptoms in the long term, but it is less likely to be the cause of acute symptoms 30 minutes post-procedure. The immediate concern in this case is more likely to be pneumothorax, which can occur more suddenly and cause these symptoms.Top of FormBottom of Form

A. This is a safe medication that is associated with minimal side effects B. Stop the medication if there is increased urination C. Change position slowly to prevent orthostatic hypotension D. Double the dose if a dose is missed at the next scheduled time

Correct Answer is C

Explanation

A. This is a safe medication that is associated with minimal side effects: Carbidopa/levodopa is an effective medication for managing the symptoms of Parkinson's disease, but it is not without side effects. Common side effects include nausea, dizziness, dyskinesia (involuntary movements), and orthostatic hypotension. It is important to be honest with clients about the potential side effects and manage them proactively, rather than describing the medication as "safe with minimal side effects," which could lead to underestimating the risks.

B. Stop the medication if there is increased urination: Increased urination is not a common or typical side effect of carbidopa/levodopa. In fact, the medication is more likely to cause urinary retention or difficulty urinating in some cases. The client should not stop taking the medication without consulting their healthcare provider. Any urinary changes should be reported, but abrupt discontinuation of the medication is not advised without medical supervision.

C. Change position slowly to prevent orthostatic hypotension: One of the common side effects of carbidopa/levodopa therapy is orthostatic hypotension, which occurs when a person experiences a drop in blood pressure upon standing up. This can lead to dizziness or fainting, increasing the risk of falls. The client should be educated to change positions slowly, such as sitting up slowly and standing up gradually from a lying position, to minimize the risk of orthostatic hypotension. This is a critical aspect of safety and should be emphasized as part of the teaching.

D. Double the dose if a dose is missed at the next scheduled time: Doubling the dose of carbidopa/levodopa if a dose is missed can lead to an overdose, which may cause serious side effects, including dyskinesias or other complications. Clients should be instructed to take the missed dose as soon as they remember, unless it is almost time for the next dose. In that case, they should skip the missed dose and continue with their regular dosing schedule. It is important to never double the dose without guidance from the healthcare provider.

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Correct Answer is B

Explanation

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