You are providing care to a patient who is being treated for aspiration pneumonia. The client is on a 100% non-rebreather mask. Which finding below is a HALLMARK sign and symptom that the client is developing acute respiratory distress syndrome (ARDS)?

The client is experiencing bradypnea.

The client's PaCO2 is 50 mmHg.

The client's blood pressure is 170/96.

The client's PaO2 remains at 40 mmHg

Answer and Explanation

The Correct Answer is D

A. Bradypnea is not a hallmark sign of ARDS; ARDS typically involves tachypnea or rapid breathing.
B. An elevated PaCO2 indicates hypercapnia but is not specific to ARDS.
C. Elevated blood pressure is not a specific indicator of ARDS.
D. A persistently low PaO2 despite receiving high-flow oxygen (such as from a non-rebreather mask) is a hallmark sign of ARDS, indicating severe hypoxemia and impaired gas exchange.

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Correct Answer is D

Explanation

A. Applying restraints should be a last resort and only if less restrictive measures have failed. It is also essential to follow legal and ethical guidelines regarding the use of restraints.

B. Calling the family to stay with the client may provide temporary comfort but does not directly address safety concerns or the underlying cause of restlessness and confusion.

C. Sedating the client might not be appropriate without first assessing the cause of the restlessness and confusion. Medications should be used cautiously and based on a thorough evaluation.

D. Moving the client closer to the nurses' station allows for more frequent monitoring and quick intervention if needed, addressing the immediate safety concern of restlessness and confusion. This measure helps ensure the client’s safety while further assessment and intervention are being planned.

A. Arteriovenous fistula B. Implanted infusion port C. Short peripheral catheter D. Peripherally inserted central catheter

Correct Answer is D

Explanation

A. An arteriovenous fistula is used for dialysis, not for long-term antibiotic therapy.
B. An implanted infusion port is suitable for long-term therapy but is typically used for medications that require infusions over weeks or months rather than prolonged IV therapy.
C. A short peripheral catheter is not appropriate for extended therapy due to the risk of thrombophlebitis and infiltration.
D. A peripherally inserted central catheter (PICC) is appropriate for long-term intravenous antibiotic therapy as it provides reliable access and reduces the risk of complications associated with extended peripheral catheter use.

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You are providing care to a patient who is being treated for aspiration pneumonia. The client is on a 100% non-rebreather mask. Which finding below is a HALLMARK sign and symptom that the client is developing acute respiratory distress syndrome (ARDS)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Explanation

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