What key feature should the nurse be aware of when ventilating clients with acute respiratory distress syndrome (ARDS)?

Do not use positive end expiratory pressure (PEEP)

Use high rates of ventilation

Place client in Trendelenburg position

Use low but adequate tidal volume

Answer and Explanation

The Correct Answer is D

A. Do not use positive end expiratory pressure (PEEP):PEEP is commonly used in ARDS management to prevent alveolar collapse and improve oxygenation. It helps keep the airways open during expiration, which is critical for patients with ARDS.

B. Use high rates of ventilation: High ventilation rates are generally avoided in ARDS as they can increase the risk of ventilator-induced lung injury. ARDS patients require controlled ventilation with careful attention to oxygen levels and carbon dioxide removal, not excessive ventilation rates.

C. Place client in Trendelenburg position: The Trendelenburg position (head down, feet elevated) is not recommended for ARDS patients. This position can increase intracranial pressure and may worsen oxygenation. The prone position is preferred for ARDS management to improve oxygenation.

D. Use low but adequate tidal volume: In ARDS, a low tidal volume strategy (typically 6 mL/kg of ideal body weight) is recommended to minimize ventilator-induced lung injury. It helps prevent overdistension of the alveoli and improves lung protection, which is crucial for ARDS patients.

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Correct Answer is A

Explanation

A. The pH is normal but leaning toward alkalosis (7.44).

The PaCO₂ is low (30 mmHg), indicating respiratory alkalosis.

The HCO₃⁻ is also low (18 mEq/L), showing metabolic compensation.

Since pH is within normal limits and both respiratory and metabolic components are abnormal, full compensation has occurred.

B. This is incorrect

C. This is incorrect

D. This is incorrect

A. Insertion of a tracheostomy to maintain the airway B. Use of noninvasive positive pressure ventilation (BIPAP) C. Endotracheal intubation with mechanical ventilation D. Administration of 50% Venturi mask

Correct Answer is B

Explanation

A. Insertion of a tracheostomy to maintain the airway: This is not the first step in the management of hypercapnic respiratory failure. A tracheostomy is usually considered in cases where prolonged mechanical ventilation is required or for patients who need long-term airway support. It would not be immediately prescribed in this situation.

B. Use of noninvasive positive pressure ventilation (BIPAP): The client is showing signs of hypercapnic respiratory failure, indicated by lethargy, slow response to commands, and low oxygen saturation (pulse ox 84%) despite receiving oxygen via a Venturi mask. BIPAP (Bilevel Positive Airway Pressure) is a form of noninvasive ventilation that can help improve both oxygenation and ventilation by providing positive pressure to help the client breathe more effectively. It is often used in cases of hypercapnic respiratory failure, especially when the patient is alert enough to tolerate the mask.

C. Endotracheal intubation with mechanical ventilation: While this may be necessary if noninvasive ventilation (like BIPAP) is not effective, endotracheal intubation is typically considered when the patient is unable to tolerate noninvasive ventilation or if their respiratory failure worsens significantly. Given that the patient is still responsive (though lethargic), BIPAP would likely be tried first.

D. Administration of 50% Venturi mask: Increasing the oxygen concentration is unlikely to resolve the underlying issue of hypercapnia (elevated CO2 levels) in this patient. Hypercapnic respiratory failure is primarily due to inadequate ventilation, not just oxygen deficiency. Therefore, a higher concentration of oxygen may not be sufficient and would not address the need for improved ventilation.

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What key feature should the nurse be aware of when ventilating clients with acute respiratory distress syndrome (ARDS)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is analyzing a client's arterial blood gas (ABG) values with the following results: pH 7.44, PaCO2 30 mmHg. PaO2 90 mmHg, and HCO3 18 mEq/L. Which acid base imbalance should the nurse associate with these results? ABG pH 7.35-7.45 PC02 35-45 mmHg pa02 80-100 mmHg PHCO3 22-26 mEq/L

Correct Answer is A

Explanation

The nurse is caring for a client with hypercapnic respiratory failure. The client is lethargic & slow to follow commands. Current vitals: BP 78/52. pulse 132. respirations 8, and pulse ox 84% on 35% Venturi mask. The nurse would anticipate which medical prescription?

Correct Answer is B

Explanation

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