The client who smokes two (2) packs of cigarettes a day develops ARDS after a near-drowning. The client asks the nurse, 'What is happening to me? Why did I get this?' Which statement by the nurse is most appropriate?

Correct Answer: C

Rationale: The correct answer is C. The nurse should provide accurate information to the client. ARDS (Acute Respiratory Distress Syndrome) is characterized by fluid buildup in the lungs, leading to breathing difficulties. In this case, near-drowning caused lung injury, resulting in ARDS. Option A is incorrect as not everyone who almost drowns develops ARDS. Option B is incorrect as platelets do not enter the alveoli in ARDS; it is primarily caused by inflammation and damage to the alveoli. Option D is incorrect as while smoking can weaken the lungs, in this scenario, near-drowning was the direct cause of ARDS.

Correct Answer: B

Rationale: The correct answer is B: Pneumothorax. High levels of PEEP in ARDS can lead to overdistension of alveoli, causing barotrauma and increasing the risk of pneumothorax. Pneumothorax is a serious complication that can lead to respiratory distress and requires immediate intervention. Pulmonary embolism (A) is a concern in ARDS but is not directly related to high PEEP levels. Bronchospasm (C) is not a common complication of high PEEP in ARDS. Pleural effusion (D) is caused by fluid accumulation in the pleural space, which is not directly related to high PEEP levels.

Correct Answer: B

Rationale: The correct answer is B: on the right side. When the patient with left lower-lobe pneumonia is positioned on the right side, gravity helps drain secretions from the affected area, improving ventilation and gas exchange. Placing the patient on the left side (A) may worsen oxygenation by further compromising the already affected lobe. High-Fowler's position (C) may not be as effective in promoting drainage as side-lying positions. The tripod position (D) is commonly used for patients with respiratory distress, but in this case, side positioning is more beneficial for improving gas exchange in the specific affected area.

Correct Answer: B

Rationale: The correct answer is B: Chest tube insertion on the left side. Tracheal deviation to the right side indicates tension pneumothorax, where air accumulates in the pleural space, displacing the mediastinum and trachea. Inserting a chest tube on the left side will decompress the pneumothorax, restoring normal breathing. Option A is incorrect because the chest tube should be inserted on the side opposite the deviation. Option C, intubation, is not the first-line treatment for tension pneumothorax. Option D, tracheostomy, is not indicated in this emergent scenario.

Correct Answer: C

Rationale: The correct answer is C: The client will be placed back on full ventilatory support. Based on the assessment findings of a respiratory rate of 32/min, oxygen saturation of 88 percent, and use of accessory muscles, the client is showing signs of respiratory distress and not tolerating CPAP. The nurse should anticipate that the client will require full ventilatory support to manage their respiratory status effectively. Increasing FiO2 (choice A) may not be sufficient to address the underlying issue. Weaning should not continue (choice B) as the client is not tolerating CPAP. Extubation (choice D) is not appropriate given the client's current respiratory status.