Question 1

Which of the following ventilatory strategies is appropriate when mechanically ventilating a patient with ARDS?

Accepted Answer

A) PEEP less than 15 cm H₂O and tidal volume (VT)between 8 and 10 mL/kg 
B) Peak inspiratory pressure (PIP)less than 40 cm H₂O and Pplateau less than 30 cm H₂O 
C) VT less than 6 mL/kg and Pplateau less than 30 cm H₂O 
D) A high or low level of PEEP and a VT between 8 and 10 mL/kg 
A) PEEP less than 15 cm H₂O and tidal volume (VT)between 8 and 10 mL/kg 
B) Peak inspiratory pressure (PIP)less than 40 cm H₂O and Pplateau less than 30 cm H₂O 
C) VT less than 6 mL/kg and Pplateau less than 30 cm H₂O 
D) A high or low level of PEEP and a VT between 8 and 10 mL/kg C

Question 2

Which of the following regions of the lungs is most likely to be unaffected by pathophysiology associated with ARDS?

Accepted Answer

A) The dependent regions of the lung 
B) The nondependent regions of the lung 
C) The middle zone of the lung 
D) Depends on the etiology 
A) The dependent regions of the lung 
B) The nondependent regions of the lung 
C) The middle zone of the lung 
D) Depends on the etiology B

Question 3

A therapist is evaluating the progress of a patient with ARDS.The arterial blood gas reveals a PaO? of 55 mm Hg and a PaCO? of 65 mm Hg.The PEEP is set at 12 cm H?O,and the mean airway pressure is 18 on an FiO? of 0.60.What is the OI in this patient?

Accepted Answer

A) 20.7 
B) 13.1 
C) 1.31 
D) 200 
A) 20.7 
B) 13.1 
C) 1.31 
D) 200 A

Question 4

The therapist was titrating PEEP levels to maintain an SaO₂ of 85% and found that 13 cm H₂O were required to achieve this goal.What should the most important concern with this level of PEEP?

Accepted Answer

A) Risk of pneumothorax 
B) Decreased cardiac output 
C) Auto-PEEP 
D) Overdistention 
A) Risk of pneumothorax 
B) Decreased cardiac output 
C) Auto-PEEP 
D) Overdistention

Question 5

Radiographically,what features are typically seen in ARDS?

Accepted Answer

A) Horizontal ribs 
B) Bilateral consolidations 
C) Flattened diaphragms 
D) Pleural effusions 
A) Horizontal ribs 
B) Bilateral consolidations 
C) Flattened diaphragms 
D) Pleural effusions

Question 6

What acid-base abnormality does a patient generally display when experiencing stage 2 of ARDS?

Accepted Answer

A) Mixed acidosis 
B) Respiratory alkalosis 
C) Respiratory acidosis 
D) Metabolic acidosis 
A) Mixed acidosis 
B) Respiratory alkalosis 
C) Respiratory acidosis 
D) Metabolic acidosis

Question 7

Which of the following pathophysiologic changes seen in ARDS is responsible for the decrease in available surface area for gas exchange?

Accepted Answer

A) Hyperinflation of the lungs 
B) Decreased right ventricular cardiac output 
C) Pulmonary hypertension 
D) Obliteration of small precapillary vessels 
A) Hyperinflation of the lungs 
B) Decreased right ventricular cardiac output 
C) Pulmonary hypertension 
D) Obliteration of small precapillary vessels

Question 8

What pathophysiologic change accounts for the alteration of the hysteresis curve during ARDS?

Accepted Answer

A) High transpulmonary pressures 
B) High transairway pressures 
C) Hyperinflated lungs 
D) Refractory hypoxemia 
A) High transpulmonary pressures 
B) High transairway pressures 
C) Hyperinflated lungs 
D) Refractory hypoxemia

Question 9

During the implementation of permissive hypercapnia,which of the following concepts is the most critical to prevent complications of this strategy?

Accepted Answer

A) The PaCO₂ should never reach 100 mm Hg. 
B) The pH should never remain below 7.30. 
C) The rate at which the CO₂ rises may be more important than the actual PaCO₂ . 
D) The target PaCO₂ should be reached in 48 hours. 
A) The PaCO₂ should never reach 100 mm Hg. 
B) The pH should never remain below 7.30. 
C) The rate at which the CO₂ rises may be more important than the actual PaCO₂ . 
D) The target PaCO₂ should be reached in 48 hours.

Question 10

Which of the following indirect insults can cause ARDS?

Accepted Answer

A) Pneumonia 
B) Chest trauma 
C) Closed head injury 
D) Cor pulmonale 
A) Pneumonia 
B) Chest trauma 
C) Closed head injury 
D) Cor pulmonale

Question 11

Which of the following pathophysiologic conditions contribute to the decreased pulmonary compliance associated with ARDS?

Accepted Answer

A) Destruction of alveolar type II cells 
B) Inactivation of pulmonary surfactant 
C) Fluid accumulation in the pleural spaces 
D) Rapid removal of fluid by the pulmonary lymphatics 
A) Destruction of alveolar type II cells 
B) Inactivation of pulmonary surfactant 
C) Fluid accumulation in the pleural spaces 
D) Rapid removal of fluid by the pulmonary lymphatics

Question 12

How should the therapist use the point on the pressure-volume loop where the shape changes from concave to exponential?

Accepted Answer

A) To set PEEP 
B) To set VT 
C) To set Ti 
D) To set PIP 
A) To set PEEP 
B) To set VT 
C) To set Ti 
D) To set PIP

Question 13

What level of FiO₂ should the therapist avoid using long term in patients with ARDS?

Accepted Answer

A) 40% 
B) 50% 
C) 60% 
D) Any level above 30% 
A) 40% 
B) 50% 
C) 60% 
D) Any level above 30%

Question 14

What level of Pplₐtₑₐᵤ should the therapist target to improve outcomes in patients with ARDS?

Accepted Answer

A) 35 cm H₂O 
B) 32 cm H₂O 
C) 25 cm H₂O 
D) 20 cm H₂O 
A) 35 cm H₂O 
B) 32 cm H₂O 
C) 25 cm H₂O 
D) 20 cm H₂O

Question 15

Which of the following interventions should the therapist implement to decrease mortality in patients with ARDS?

Accepted Answer

A) High PEEP 
B) Alveolar recruitment maneuvers 
C) Low tidal volume 
D) High respiratory rate 
A) High PEEP 
B) Alveolar recruitment maneuvers 
C) Low tidal volume 
D) High respiratory rate

Question 16

What are some of the physical signs of respiratory failure among children?
I.Head bobbing
II.Nasal flaring
III.Crying
IV.Grunting

Accepted Answer

A) I and II only 
B) I,II,and IV only 
C) I,III,and IV only 
D) II,III,and IV only 
A) I and II only 
B) I,II,and IV only 
C) I,III,and IV only 
D) II,III,and IV only

Question 17

On the basis of the Berlin definition of Acute Respiratory Distress Syndrome (ARDS),the definition of moderate acute respiratory distress syndrome comprises which of the following components?
I.PaO₂/FiO₂ £200 mm Hg
II.Onset of respiratory symptoms within 1 week of clinical insult
III.Pulmonary capillary wedge pressure greater than 18 mm Hg
IV.Chest radiograph with bilateral infiltrates not fully explained by effusions or collapse

Accepted Answer

A) I and II only 
B) I and III only 
C) II and IV only 
D) I,II,and IV only 
A) I and II only 
B) I and III only 
C) II and IV only 
D) I,II,and IV only

Question 18

The therapist is auscultating a 2-year-old patient with ARDS.Which of the following is a common auscultatory finding in ARDS?

Accepted Answer

A) Wheezing 
B) Stridor 
C) Crackles 
D) Pleural rub 
A) Wheezing 
B) Stridor 
C) Crackles 
D) Pleural rub

Question 19

Which of the following clinical signs characterizes the onset of the third stage of ARDS?

Accepted Answer

A) Refractory hypoxemia 
B) Hypocarbia 
C) Increased anatomic dead space 
D) Decreased cardiac output 
A) Refractory hypoxemia 
B) Hypocarbia 
C) Increased anatomic dead space 
D) Decreased cardiac output

Exam 29: Acute Respiratory Distress Syndrome

Which of the following ventilatory strategies is appropriate when mechanically ventilating a patient with ARDS?

Which of the following regions of the lungs is most likely to be unaffected by pathophysiology associated with ARDS?

A therapist is evaluating the progress of a patient with ARDS.The arterial blood gas reveals a PaO? of 55 mm Hg and a PaCO? of 65 mm Hg.The PEEP is set at 12 cm H?O,and the mean airway pressure is 18 on an FiO? of 0.60.What is the OI in this patient?

The therapist was titrating PEEP levels to maintain an SaO₂ of 85% and found that 13 cm H₂O were required to achieve this goal.What should the most important concern with this level of PEEP?

Radiographically,what features are typically seen in ARDS?

What acid-base abnormality does a patient generally display when experiencing stage 2 of ARDS?

Which of the following pathophysiologic changes seen in ARDS is responsible for the decrease in available surface area for gas exchange?

What pathophysiologic change accounts for the alteration of the hysteresis curve during ARDS?

During the implementation of permissive hypercapnia,which of the following concepts is the most critical to prevent complications of this strategy?

Which of the following indirect insults can cause ARDS?

Which of the following pathophysiologic conditions contribute to the decreased pulmonary compliance associated with ARDS?

How should the therapist use the point on the pressure-volume loop where the shape changes from concave to exponential?

What level of FiO₂ should the therapist avoid using long term in patients with ARDS?

What level of Pplₐtₑₐᵤ should the therapist target to improve outcomes in patients with ARDS?

Which of the following interventions should the therapist implement to decrease mortality in patients with ARDS?

What are some of the physical signs of respiratory failure among children? I.Head bobbing II.Nasal flaring III.Crying IV.Grunting

The therapist is auscultating a 2-year-old patient with ARDS.Which of the following is a common auscultatory finding in ARDS?

Which of the following clinical signs characterizes the onset of the third stage of ARDS?

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