ALI v ARDS
A patient with sepsis develops tachypnea and anxiety. ABG shows PaO₂ 72, PaCO₂ 30, pH 7.48. Oxygen improves saturation.
What is most likely occurring?
A. ARDS
B. Acute lung injury
C. Respiratory failure
D. Metabolic acidosis
Answer: B
Rationale: Early ALI = mild hypoxemia + respiratory alkalosis with compensation. Oxygen still helps.
A patient is in early ARDS. Which findings are expected?
A. Tachypnea
B. Respiratory alkalosis
C. Cyanosis
D. Anxiety
E. Decreased respiratory rate
Answers: A, B, D
Rationale: Early = compensation (fast breathing, alkalosis, anxiety). Cyanosis and ↓RR are late.
Why is PEEP used in ARDS?
A. Improve cardiac output
B. Reduce inflammation
C. Keep alveoli open
D. Increase hemoglobin
Answer: C
Rationale: PEEP keeps alveoli open at the end of exhalation, preventing collapse and improving oxygenation. It does not directly affect inflammation, cardiac output, or hemoglobin.
A ventilated patient develops fever, increased secretions, and a new infiltrate on chest x-ray.
What is the priority concern?
A. Barotrauma
B. ARDS progression
C. Ventilator-associated pneumonia
D. Volutrauma
Answer: C
Rationale: VAP is common in intubated patients because the ET tube bypasses normal defenses, allowing bacteria into the lungs. Fever, secretions, and infiltrates are classic signs.
Which are hallmark features of ARDS?
A. Refractory hypoxemia
B. Elevated wedge pressure
C. Bilateral infiltrates
D. Decreased lung compliance
E. Rapid improvement with oxygen
Answers: A, C, D
Rationale:
A patient with pneumonia is worsening. Which findings indicate progression to ARDS?
A. Hypoxemia not improving with oxygen
B. Bilateral infiltrates on chest x-ray
C. Elevated wedge pressure
D. Decreased lung compliance
E. Productive cough
Answers: A, B, D
Rationale: ARDS = refractory hypoxemia, bilateral infiltrates, stiff lungs. Wedge pressure is normal.
A patient becomes drowsy with shallow respirations after being tachypneic earlier.
What is happening?
A. Improvement
B. Anxiety relief
C. Fatigue and deterioration
D. Pain control effect
Answer: C
Rationale: Transition from compensation → respiratory failure.
Which are effects of PEEP?
A. Prevents alveolar collapse
B. Decreases oxygenation
C. Increases intrathoracic pressure
D. Improves oxygenation
E. Can cause lung injury
Answers: A, C, D, E
Rationale:
Which complications are associated with ARDS treatment?
A. Stress ulcers
B. Renal failure
C. Barotrauma
D. Volutrauma
E. Hyperkalemia
Answers: A, B, C, D
Rationale:
Which patient is highest priority?
A. Mild dyspnea with normal ABG
B. Productive cough with fever
C. Anxiety with tachypnea
D. Hypoxemia despite 80% FiO₂
Answer: D
Rationale: This indicates refractory hypoxemia → ARDS → immediate intervention needed.
A patient initially presents with ALI but improves after antibiotics and oxygen therapy.
What explains this?
A. ARDS always resolves quickly
B. ALI can be reversible
C. ARDS was misdiagnosed
D. Hypoxemia was unrelated
Answer: B
Rationale: Not all ALI progresses to ARDS if treated early.
Which findings indicate late ARDS?
A. Confusion
B. Tachypnea with alkalosis
C. Cyanosis
D. Accessory muscle use
E. Hypoxemia despite oxygen
Answers: A, C, D, E
Rationale: Late = severe hypoxia + fatigue. Alkalosis is early.
After increasing PEEP, a patient develops sudden hypoxia and absent breath sounds on one side.
What is most likely?
A. Atelectasis
B. Barotrauma
C. Pneumonia
D. Pulmonary edema
Answer: B
Rationale: High PEEP can cause alveolar rupture (barotrauma), leading to pneumothorax, which presents as sudden hypoxia and absent breath sounds on one side.
Which describes volutrauma?
A. Infection due to ventilator use
B. Pressure-induced alveolar rupture
C. Overstretching of alveoli from large volumes
D. Fluid accumulation in lungs
Answer: C
Rationale: Volutrauma occurs when alveoli are overdistended from large tidal volumes. Pressure damage is barotrauma.
Which findings differentiate ARDS from heart failure?
A. Elevated BNP
B. Normal wedge pressure
C. Bilateral infiltrates
D. Cardiac cause present
E. Non-cardiac lung injury
Answers: B, C, E
Rationale:
Which patients are at highest risk for developing ARDS?
A. Patient with pancreatitis
B. Patient with asthma exacerbation
C. Patient with sepsis
D. Patient after aspiration event
E. Patient with stable COPD
Answers: A, C, D
Rationale: Indirect (sepsis, pancreatitis) and direct (aspiration) causes → ARDS risk.
Which ABG indicates worsening ARDS?
A. pH 7.48, CO₂ 30
B. pH 7.50, CO₂ 28
C. pH 7.36, CO₂ 42
D. pH 7.25, CO₂ 55
Answer: D
Rationale: CO₂ retention + acidosis = failure.
Which interventions improve oxygenation in ARDS?
A. Mechanical ventilation
B. Oxygen therapy alone
C. Prone positioning
D. PEEP
E. Decreasing FiO₂
Answers: A, C, D
Rationale:
Why are ARDS patients at risk for stress ulcers?
A. Increased GI perfusion
B. Critical illness stress response
C. Ventilator use
D. Decreased blood flow to GI tract
E. Increased oral intake
Answers: B, C, D
Rationale:
A patient is hypoxic despite oxygen and is becoming confused and fatigued.
What is the priority intervention?
A. Encourage fluids
B. Provide reassurance
C. Reposition patient
D. Prepare for intubation
Answer: D
Rationale: These are signs of respiratory failure. The airway must be secured immediately.
A patient requires 80% FiO₂ but remains hypoxic. What does this indicate?
A. ALI improving
B. Anxiety
C. ARDS
D. Mild hypoventilation
Answer: C
Rationale: Hypoxemia despite high oxygen = hallmark ARDS.
A patient is deteriorating. Which signs indicate need for intubation?
A. Decreasing respiratory rate
B. Mild tachypnea
C. Confusion
D. Increasing work of breathing
E. Hypoxemia despite oxygen
Answers: A, C, D, E
Rationale: These show failure. Mild tachypnea alone is early.
Why must PEEP be increased gradually?
A. Prevent infection
B. Improve comfort
C. Avoid lung damage
D. Reduce anxiety
Answer: C
Rationale: Increasing PEEP too quickly can cause barotrauma (pressure damage) and volutrauma (overstretching). Gradual increases allow safe recruitment of alveoli without injury.
A patient with ARDS develops decreased urine output and rising creatinine.
What is the most likely cause?
A. Fluid overload
B. Kidney infection
C. Increased oxygen delivery
D. Poor perfusion and hypoxia
Answer: D
Rationale: ARDS causes systemic hypoxia and often hypotension, leading to decreased kidney perfusion and acute kidney injury.
Which interventions are essential in ARDS management?
A. Mechanical ventilation
B. PEEP
C. Prone positioning
D. Treat underlying cause
E. Withhold oxygen
Answers: A, B, C, D
Rationale: