The client diagnosed with ARDS is transferred to the intensive care department and placed on a ventilator. Which intervention should the nurse implement first?

Correct Answer: C

Rationale: The correct answer is C. Assess the respiratory status and pulse oximeter reading. This is the first intervention the nurse should implement because it provides crucial information about the client's current oxygenation status and respiratory function. By assessing these parameters, the nurse can quickly identify any immediate issues that may require intervention, such as respiratory distress or hypoxemia. Confirming ventilator settings (A) and verifying ventilator alarms (B) are important tasks but assessing the client's respiratory status takes priority as it directly impacts the client's oxygenation and ventilation. Monitoring arterial blood gas results (D) is important for evaluating the effectiveness of ventilation but is not the first step in managing a client on a ventilator.

Correct Answer: B

Rationale: The correct answer is B, impaired gas exchange due to alveolar-capillary membrane damage. In ARDS, inflammation and injury to the alveolar-capillary membrane lead to increased permeability and fluid accumulation, impairing gas exchange. Reduced hemoglobin levels (choice A) do not directly cause hypoxemia in ARDS. Decreased perfusion to pulmonary capillaries (choice C) may contribute to hypoxemia but is not the primary mechanism in ARDS. Increased airway resistance due to bronchoconstriction (choice D) affects ventilation, not gas exchange, and is not the primary cause of hypoxemia in ARDS.

Correct Answer: B

Rationale: The correct answer is B: Cardiac output and blood pressure. In ARDS patients on high PEEP, monitoring cardiac output and blood pressure is crucial due to the risk of hemodynamic compromise. High PEEP can decrease venous return, leading to decreased cardiac output and hypotension. Monitoring these parameters helps detect and prevent complications like hypotension, which can further compromise oxygenation. Choice A is incorrect because while monitoring respiratory rate and depth is important in ARDS, the priority in this scenario is monitoring hemodynamic status due to the potential impact of high PEEP on cardiac function. Choice C is incorrect as monitoring white blood cell count is not directly related to complications of high PEEP in ARDS patients. Choice D is incorrect because sputum production and characteristics are not the priority for monitoring in this scenario; cardiac output and blood pressure are more critical indicators of potential complications.

Correct Answer: A

Rationale: The correct answer is A: Dyspnea and tachypnea. These are common early clinical manifestations of ARDS because the condition leads to rapid, shallow breathing (tachypnea) and shortness of breath (dyspnea) due to the impaired gas exchange in the lungs. Cyanosis and apprehension (B) may occur later in ARDS progression. Hypotension and tachycardia (C) are more associated with septic shock rather than early ARDS. Respiratory distress and frothy sputum (D) are more characteristic of conditions like pulmonary edema rather than ARDS.

Correct Answer: D

Rationale: The correct answer is D: End tidal CO2 monitoring. This is the first assessment of tube placement because it provides immediate feedback on the effectiveness of ventilation. End tidal CO2 monitoring measures the amount of CO2 exhaled, indicating proper placement in the airway. If the tube is correctly positioned, CO2 will be detected. Chest X-Ray (A) is not immediate and delays intervention. Auscultation (B) may not always confirm placement. Pulse oximetry (C) can be misleading as oxygen saturation can be maintained even with incorrect tube placement.