CH28

Which of the following materials will be found in the intraalveolar walls of a patient with ARDS?

1.Leukocytes
2.Cellular debris
3.Fibrin
4.Hyaline membrane

A. 1, 4
B. 2, 3, 4
C. 2, 3
D. 1, 2, 3

A patient has a prolonged case of ARDS. What changes would be expected in the patient’s alveolar cells?

A. Development of emphysema
B. Influx of macrophages
C. Hyperplasia and swelling of the type II cells
D. Multiplication of the type I cells

Which of the following pulmonary changes are associated with ARDS?

1.Abnormal surfactant
2.Interstitial edema
3.Decreased shunt
4.Narrowing of the alveolar-capillary membrane

A. 3, 4
B. 1, 2, 3
C. 1, 3
D. 1, 2

What is the reason for the elevated risk for developing ARDS associated with massive blood transfusions?

A. Shock (hypovolemia)
B. Fat emboli
C. Blockages in pulmonary blood vessels
D. Receiving the wrong blood type

ARDS can result from the inhalation of all of:

1.FIO2 >0.60 for prolonged exposure.
2.nitrogen dioxide.
3.very dry air.
4.chlorine gas.

A. 1, 2, 4
B. 2, 3, 4
C. 1, 3
D. 1, 2, 3

Which of the following are causes of ARDS?

1.Liver failure
2.Drug abuse
3.Septicemia
4.Goodpasture’s syndrome

A. 1, 4
B. 2, 3, 4
C. 1, 3, 4
D. 2, 3

Which of the following are recommended to treat alveolar consolidation and atelectasis associated with ARDS?

1. Aerosolized bronchodilator medications
2. Continuous positive airway pressure (CPAP)
3. Chest percussion and postural drainage
4. Positive end-expiratory pressure (PEEP)

A. 2, 4
B. 1, 3
C. 4
D. 1, 2

Which of the following are current ventilatory strategies in the treatment of ARDS?

1. Large tidal volume
2. Small tidal volume
3. Rapid respiratory rates
4. Slow respiratory rates

A. 1, 4
B. 2
C. 3
D. 2, 3

What initial tidal volume setting on the ventilator would be recommended for a 70-kg adult male with ARDS?

A. 700 mL
B. 560 mL
C. 350 mL
D. 420 mL

Which of the following would be low tidal volume ventilation goals in a patient with ARDS?

1.Decrease barotrauma.
2.Maintain plateau pressure >30 cm H2O.
3.Decrease high transpulmonary pressures.
4.Reduce overdistention of the lungs.

A. 1, 3, 4
B. 1
C. 2, 3, 4
D. 2, 3

Breath sounds associated with ARDS include:

1.vesicular.
2.bronchovesicular.
3.crackles.
4.bronchial.

A. 4
B. 1, 2
C. 2, 3, 4
D. 3, 4

Which of the following clinical manifestations are associated with ARDS?

1.Increased pulmonary capillary wedge pressure (PCWP)
2.Increased CVP
3.Intercostal retractions
4.Cyanosis

A. 3, 4
B. 2, 3, 4
C. 1, 3, 4
D. 1, 2

The chest radiograph finding indicative of severe ARDS is:

A. pleural effusion.
B. tracheal deviation.
C. bilateral hyperinflation of the lungs.
D. “ground-glass” appearance of the lungs.

According to the Berlin definition of ARDS, what does a PaO2/FIO2 ratio of 150 mm Hg indicate for a patient on mechanical ventilation with a PEEP of 10 cm H2O?

A. Normal lungs
B. Moderate ARDS
C. Mild ARDS
D. Severe ARDS

What is the most common cause of ARDS?

A. Fat embolism
B. Aspiration of gastric contents
C. Inhalation of irritants
D. Sepsis

When would symptoms of ARDS associated with a fat embolism from a long bone fracture be most likely to develop?

A. 4 to 12 hours following the fracture
B. 2 to 4 hours following the fracture
C. 12 to 48 hours following the fracture
D. 48 to 96 hours following the fracture

The clinical manifestations associated with ARDS usually appear:

A. 4 to 12 hours following the inciting event.
B. 2 to 4 hours following the inciting event.
C. 72 to 96 hours following the inciting event.
D. 6 to 72 hours following the inciting event.

Permissive hypercapnia is typically allowed to:

A. protect the lungs from high tidal volumes.
B. protect the lungs from high airway pressures.
C. protect the lungs from fluid accumulation.
D. protect the lungs from high PaO2 levels.

During permissive hypercapnia, at what pH level does the increasing PaCO2 become a concern?
A. 7.6
B. 7.5
C. 7.3
D. 7.2