A 63-year-old patient is retiring from his job at an accounting firm where he was in a management role for the past 20 years. He has been with the same company for 42 years and was a dedicated employee. His wife is a homemaker. She raised their five children, babysits for her grandchildren as needed, and belongs to numerous church committees. What are the major concerns for this patient? (Select all that apply.)

Correct Answer: A

Rationale: Step 1: The patient retiring from a management role after 20 years indicates a significant change in his daily routine and identity. Step 2: Being a dedicated employee for 42 years, work has likely been a major part of his life. The loss of his work role can lead to a sense of loss, purposelessness, and identity crisis. Step 3: Social isolation (choice B) may be a concern, but the question emphasizes the patient's work role and dedication, making choice A more critical. Step 4: The wife's employment status (choice C) and household tasks division (choice D) are not directly related to the patient's major concerns. Summary: The major concern for the patient is the loss of his work role, which can impact his sense of purpose and identity. Social isolation, the wife's employment, and household tasks division are not as significant in this context.

Correct Answer: C

Rationale: The correct answer is C. In an intrapulmonary shunt, blood flows through the capillaries in the lungs without participating in gas exchange. This leads to poorly oxygenated blood mixing with well-oxygenated blood, reducing overall oxygenation levels. Choice A is incorrect because it describes a ventilation-perfusion mismatch, not an intrapulmonary shunt. Choice B is incorrect as it describes an intracardiac shunt, not an intrapulmonary shunt. Choice D is incorrect as it refers to conditions like pulmonary fibrosis, not intrapulmonary shunts.

Correct Answer: B

Rationale: The correct answer is B: To minimize the risk of barotrauma and volutrauma. Low tidal volume ventilation in ARDS reduces the risk of lung injury by decreasing the pressure and volume delivered to the lungs, thus lowering the chances of barotrauma (lung injury from high pressure) and volutrauma (lung injury from excessive volume). This strategy helps protect the fragile alveoli, prevents further damage, and improves outcomes. Choice A is incorrect because low tidal volume ventilation does not directly prevent fluid accumulation in the alveoli. Choice C is incorrect because it focuses on carbon dioxide elimination, which is not the primary goal of low tidal volume ventilation in ARDS. Choice D is incorrect because although improving perfusion in dependent lung areas is important, it is not the primary benefit of low tidal volume ventilation in ARDS.

Correct Answer: A

Rationale: The correct answer is A: PaO2/FiO2 ratio less than 200. This ratio is a key indicator in diagnosing ARDS, with a value below 200 being a hallmark of the condition. ARDS is characterized by severe hypoxemia, which is reflected in a low PaO2/FiO2 ratio. The other choices are incorrect because bilateral wheezing (B) is more suggestive of asthma or COPD exacerbation, hyperinflation on chest x-ray (C) is not specific to ARDS, and fever and purulent sputum (D) may indicate an infection but are not specific to ARDS progression.

Correct Answer: C

Rationale: Rationale for Choice C: Providing frequent mouth care and oral hygiene is key to preventing ventilator-associated pneumonia in ARDS patients. This intervention helps reduce the risk of oral bacteria entering the lungs, which can lead to pneumonia. Maintaining oral hygiene also decreases the colonization of pathogens in the oropharynx, reducing the risk of aspiration. This intervention is supported by evidence-based practice guidelines for preventing ventilator-associated pneumonia. Summary of other choices: A: Scheduled prophylactic nasopharyngeal suctioning is not recommended as a routine preventive measure for ventilator-associated pneumonia in ARDS patients. B: Instilling normal saline down the endotracheal tube can increase the risk of infection and does not address the root cause of ventilator-associated pneumonia. D: Using high tidal volumes on the ventilator can exacerbate lung injury in ARDS patients and is not a preventive measure for ventilator-associated pneumonia.